Department of Surgery, Austin Hospital, Level 8, 145 Studley Street, Heidelberg, VIC 3084, Australia.
World J Surg. 2013 Sep;37(9):2039-45. doi: 10.1007/s00268-013-2109-3.
Stomal site incisional hernia is a common complication following ileostomy closure. The effectiveness of prophylactic mesh placement at the time of stomal closure is unknown because of fear of mesh infection and subsequent wound complications. The present study investigated whether prophylactic mesh placement reduces the rate of incisional hernia after ileostomy closure without increasing wound complications. The study was based on retrospective review of consecutive ileostomy closures undertaken at a tertiary referral center between January 2007 and December 2011. Hernias were identified through clinical examination and computed tomography.
Eighty-three cases of ileostomy closure were reviewed; 47 patients received mesh reinforcement, and 36 underwent non-mesh closure (controls). In total, 16 (19.3 %) patients developed incisional hernia, 13 (36.1 %) of which occurred in the control group; 3 (6.4 %), in the mesh group [odds ratio (OR): 8.29; 95 % confidence interval (CI) 2.14-32.08; p = 0.001]. Incisional hernia repair was performed in 3 (23 %) patients in the control group; no hernias in the mesh group required surgery. There was no significant difference in wound infection rates between mesh (2 patients, 4.3 %) and control (1 patient, 2.8 %) groups. No mesh infection was found. Multivariate analysis demonstrated that malignancy (OR: 21.93, 95 % CI 1.58-303.95; p = 0.021) and diabetes (OR: 20.98, 95 % CI 3.23-136.31; p = 0.001) independently predicted incisional herniation, while mesh reinforcement prevented hernia development (OR: 0.06, 95 % CI 0.01-0.36; p = 0.002).
Mesh placement significantly reduced the incidence of incisional hernia following ileostomy closure, but without increasing complication rates. This technique should be strongly considered in patients at high risk of hernia development.
肠造口还纳术后切口疝是一种常见的并发症。由于担心网片感染和随后的伤口并发症，在肠造口关闭时预防性放置网片的效果尚不清楚。本研究旨在探讨预防性放置网片是否可以降低肠造口还纳术后切口疝的发生率，而不增加伤口并发症。该研究基于对 2007 年 1 月至 2011 年 12 月在一家三级转诊中心连续进行的肠造口还纳术的回顾性分析。通过临床检查和计算机断层扫描来确定疝的发生。
共回顾了 83 例肠造口还纳术，其中 47 例患者接受了网片加固，36 例患者未行网片覆盖（对照组）。共有 16 例（19.3%）患者发生切口疝，其中对照组 13 例（36.1%），网片组 3 例（6.4%）[比值比（OR）：8.29；95%置信区间（CI）：2.14-32.08；p=0.001]。对照组中有 3 例（23%）患者需要进行切口疝修补术，而网片组中没有患者需要手术。网片组（2 例，4.3%）和对照组（1 例，2.8%）的伤口感染率无显著差异。未发现网片感染。多因素分析显示，恶性肿瘤（OR：21.93，95%CI 1.58-303.95；p=0.021）和糖尿病（OR：20.98，95%CI 3.23-136.31；p=0.001）是切口疝发生的独立预测因素，而网片加固可预防疝的发生（OR：0.06，95%CI 0.01-0.36；p=0.002）。
肠造口还纳术后预防性放置网片可显著降低切口疝的发生率，且不增加并发症发生率。对于有较高疝发生风险的患者，应强烈考虑这种技术。
