Department of Surgery, Frölunda Specialist Hospital, Box 138, 421 22 Västra Frölunda, Gothenburg, Sweden.
Hernia. 2013 Aug;17(4):493-7. doi: 10.1007/s10029-012-0988-0. Epub 2012 Sep 13.
The purpose of this study was to establish long-term outcome after elective adult umbilical hernia (AUH) repair.
Peri- and postoperative data considering all consecutive procedures at our institution during the time span from 1999 to 2009 were retrospectively gathered and followed by a questionnaire and, if needed, a clinical investigation in early 2011.
A total of 162 patients (female/male 35 %/65 %) were operated, and 144/162 (89 %) answers were gathered, mean follow-up time 70 months; 77 % were sutured, non-mesh repairs; 94 % of all AUHs were smaller than 3 cm; and 49 % of the operations were performed under local anaesthesia. No perioperative complications were encountered. Five postoperative complications were encountered, two serious, both after mesh-based repairs. Wound infection rate (SSI) was low, 2/144 (1.4 %). 7/144 (4.9 %) recurrences were registered, none if mesh-based techniques were used, giving a recurrence rate of 6.3 % in suture-based repairs, the difference, however, not statistically significant (p = 0.141); 2 % reported persistent pain at follow-up, 89 % were overall satisfied with the outcome.
AUH repair could be performed with low early and long-term complication rates, with low recurrence rates also after non-mesh repairs. A substantial cohort of patients will unnecessary be implanted with meshes if mesh-reinforced repairs should be used on a routine basis, that is, 16 surplus meshes to prevent one recurrence in the present study. We recommend a tailored approach to AUH repair: suture-based methods with defects smaller than 2 cm and mesh-based repairs considered if larger than that.
本研究旨在建立成人脐疝（AUH）择期修复的长期结果。
回顾性收集了 1999 年至 2009 年期间我院所有连续手术的围手术期数据，并于 2011 年初进行了问卷调查，如果需要，还进行了临床检查。
共对 162 例患者（女性/男性 35%/65%）进行了手术，其中 144/162（89%）例患者回答了问题，平均随访时间为 70 个月；77%采用缝线修复，而非网片修复；94%的 AUH 小于 3cm；49%的手术在局部麻醉下进行。未发生围手术期并发症。术后发生 5 例并发症，其中 2 例严重，均发生在网片修复后。伤口感染率（SSI）较低，为 2/144（1.4%）。记录到 7/144（4.9%）的复发，而使用网片修复的患者无一例复发，缝线修复的复发率为 6.3%，但差异无统计学意义（p=0.141）；2%的患者在随访时报告持续疼痛，89%的患者对治疗结果总体满意。
AUH 修复可获得较低的早期和长期并发症发生率，非网片修复的复发率也较低。如果常规使用网片加强修复，将会有大量患者被植入网片，而在本研究中，为预防 1 例复发，需要额外使用 16 个网片。我们建议根据 AUH 修复的具体情况选择方法：对于小于 2cm 的缺损，采用缝线修复方法；对于大于 2cm 的缺损，采用网片修复方法。
