Cobb William S, Warren Jeremy A, Ewing Joseph A, Burnikel Alex, Merchant Miller, Carbonell Alfredo M
Department of Surgery, Greenville Health System, Greenville, SC.
Department of Surgery, Greenville Health System, Greenville, SC.
J Am Coll Surg. 2015 Apr;220(4):606-13. doi: 10.1016/j.jamcollsurg.2014.12.055. Epub 2015 Jan 28.
Mesh repair of incisional hernias has been consistently shown to diminish recurrence rates after repair, with an increased risk of infectious complications. We present a consecutive series of elective, retrorectus mesh repairs of the abdominal wall and attempt to determine predictors of wound events and recurrence.
A retrospective review was performed to include elective, retromuscular mesh repairs of complex incisional hernias from August 2006 to August 2013. Demographics, operative details, and postoperative events including wound events, surgical site infections (SSI), and recurrences were recorded.
Over the 7-year period, 255 retromuscular mesh repairs of midline incisional defects were performed. Median age of the patients was 58 years, with an average BMI of 32.2 kg/m(2). Average size of the fascial defect was 181.4 cm(2), with recurrent defects making up 48% of repairs. Wound events occurred in 37.7% of cases; SSIs occurred in 19.6% of cases. Recurrence rate was 16.9%, with mean time to recurrence of 19.2 months. With respect to mesh type, recurrences were 16.2% with synthetic, 17.1% for bioabsorbable, and 25% for biologic mesh. When evaluating polypropylene meshes, recurrence was more likely with lightweight mesh (22.9%) vs midweight mesh (10.6%) (p = 0.045). Predictors of SSI included history of mesh infection (odds ratio [OR] 4.8, 95% CI 1.9 to 12.1; p < 0.001) and recurrent repairs (OR 2.5, 95% CI 1.1 to 5.8; p < 0.05). The only predictor of recurrence was the presence of an SSI (OR 3.1, 95% CI 1.5 to 6.3; p < 0.01).
Wound events are common after open mesh repairs of complex incisional hernias. Previous mesh infections and recurrent repairs increase the likelihood of an SSI, which significantly increases the risk of recurrence. Recurrences after retrorectus mesh repairs are significantly higher with lightweight compared with mid-weight meshes.
切口疝的补片修补术一直被证明可降低修补术后的复发率，但感染并发症的风险会增加。我们呈现了一系列连续的腹壁经腹直肌后补片修补术，并试图确定伤口事件和复发的预测因素。
进行了一项回顾性研究，纳入2006年8月至2013年8月期间对复杂切口疝进行的选择性经肌后补片修补术。记录了人口统计学资料、手术细节以及术后事件，包括伤口事件、手术部位感染（SSI）和复发情况。
在这7年期间，对中线切口缺损进行了255例经肌后补片修补术。患者的中位年龄为58岁，平均体重指数为32.2kg/m²。筋膜缺损的平均大小为181.4cm²，其中复发性缺损占修补术的48%。37.7%的病例发生了伤口事件；19.6%的病例发生了手术部位感染。复发率为16.9%，平均复发时间为19.2个月。关于补片类型，合成补片的复发率为16.2%，生物可吸收补片为17.1%，生物补片为25%。在评估聚丙烯补片时，轻质补片的复发率（22.9%）高于中质补片（10.6%）（p = 0.045）。手术部位感染的预测因素包括补片感染史（比值比[OR] 4.8，95%置信区间1.9至12.1；p < 0.001）和复发性修补术（OR 2.5，95%置信区间1.1至5.8；p < 0.05）。复发的唯一预测因素是存在手术部位感染（OR 3.1，95%置信区间1.5至6.3；p < 0.01）。
复杂切口疝开放补片修补术后伤口事件很常见。既往补片感染和复发性修补术会增加手术部位感染的可能性，而手术部位感染会显著增加复发风险。与中质补片相比，经腹直肌后补片修补术后轻质补片的复发率显著更高。
