Westen Mikkel, Christoffersen Mette W, Jorgensen Lars N, Stigaard Trine, Bisgaard Thue
Gastrounit, Surgical Divison, Hvidovre University Hospital, Kettegård Alle 30, 2650, Hvidovre, Denmark.
Langenbecks Arch Surg. 2014 Jan;399(1):65-9. doi: 10.1007/s00423-013-1119-9. Epub 2013 Sep 14.
Umbilical and epigastric hernia repairs are minor, but are commonly conducted surgical procedures. Long-term results have only been sparsely investigated. Our objective was to investigate the risk of chronic complaints after a simple sutured repair for small umbilical and epigastric hernias.
A retrospective cohort study with a 5-year questionnaire and clinical follow-up was conducted. Patients undergoing primary elective, open non-mesh umbilical or epigastric sutured hernia repair were included. Patients completed a structured questionnaire regarding chronic complaints during work and leisure activities using a verbal rating scale. The primary outcome was chronic complaints.
A total of 295 patients were included for analysis after a median of 5.0-year (range 2.8-8.0) follow-up period. Follow-up results were achieved from 262 of the included patients (90 % response rate). Up till 5.8 % of the patients reported moderate or severe pain and discomfort. Work and leisure activities were restricted in 8.5 and 10.0 % of patients, respectively. Patients with chronic complaints had a higher incidence of recurrence (clinical and reoperation), than patients with none or mild complaints (78.6 vs. 22.2 % (P < 0.001)). The recurrence rate was significantly higher after a repair with absorbable suture (20.1 %) compared with non-absorbable suture repair (4.2 %) (P < 0.001).
We found that chronic complaints after a simple sutured umbilical or epigastric repair was in the level of 5.5 % and could in part be explained by recurrence. Furthermore, absorbable suture should be omitted to reduce risk of recurrence.
脐疝和上腹疝修补术虽属小型手术,但却是常见的外科手术。长期效果的研究较少。我们的目的是调查小型脐疝和上腹疝单纯缝合修补术后慢性不适的风险。
进行一项回顾性队列研究,采用5年问卷调查和临床随访。纳入接受初次择期开放性非补片脐疝或上腹疝缝合修补术的患者。患者使用言语评定量表完成一份关于工作和休闲活动中慢性不适的结构化问卷。主要结局是慢性不适。
在中位5.0年(范围2.8 - 8.0年)的随访期后,共纳入295例患者进行分析。262例纳入患者(应答率90%)获得了随访结果。高达5.8%的患者报告有中度或重度疼痛及不适。工作和休闲活动受限的患者分别为8.5%和10.0%。有慢性不适的患者复发(临床复发和再次手术)发生率高于无或轻度不适的患者(78.6%对22.2%,P < 0.001)。与不可吸收缝线修补相比,可吸收缝线修补后的复发率显著更高(20.1%对4.2%,P < 0.001)。
我们发现,脐疝或上腹疝单纯缝合修补术后慢性不适发生率为5.5%,部分原因可能是复发。此外,应避免使用可吸收缝线以降低复发风险。