Danzig M R, Stey A M, Yin S S, Qiu S, Divino C M
Department of Surgery, Icahn School of Medicine at Mount Sinai Medical Center, New York, NY, 10029, USA.
Hernia. 2016 Apr;20(2):239-47. doi: 10.1007/s10029-015-1381-6. Epub 2015 May 13.
The belief that irreducible hernias are repaired less successfully and with higher morbidity drives patients to seek elective repair. The aims of this study were threefold. First, this study sought to compare characteristics of patients undergoing irreducible and reducible ventral hernia repair. Second, to compare morbidity rates. Third, to determine which factors, including irreducibility, might be associated with recurrence.
This observational study was a retrospective review of 252 consecutive ventral hernia patients divided into two cohorts: 101 patients who underwent repair of an irreducible ventral hernia, and 152 patients underwent repair of a reducible ventral hernia. The mean follow-up time was approximately 4 years in both groups.
Patients undergoing repair of irreducible hernias had higher median BMI (31 vs. 27 kg/m2, p = 0.005), had their hernias longer (median 34 months compared to 12 months, p = 0.043), had more defects on average (mean 1.8 vs. 1.4, p < 0.001), and were more likely to be symptomatic (83 vs. 55%, p = 0.002). Interestingly, neither hernia size (p = 0.821), nor the location of hernia (p = 0.261) differed significantly between the two groups. Morbidity rates, including rates of surgical site infection, obstruction, and recurrence, did not differ significantly; nor did recurrence-free survival (RFS) distributions. Risk factors for hernia recurrence on multivariate analysis included the repaired hernia being itself recurrent (HR = 2.06, 95% CI = 1.07-3.99, p = 0.031), the occurrence of post-operative surgical site infection (HR = 5.10, 95% CI = 2.18-11.91, p < 0.001), and the occurrence of post-operative intestinal obstruction (HR = 5.18, 95% CI = 1.82-14.75, p = 0.002). Irreducibility was not a significant predictor of recurrence (p = 0.152).
Despite differing profiles, patients with these two types of hernias did not have statistically significant differences in morbidity. Recurrence was not observed to be associated with irreducibility but was found to be associated with other post-operative complications.
认为不可复性疝修补手术成功率较低且并发症发生率较高的观念促使患者寻求择期修补术。本研究有三个目的。其一，本研究旨在比较接受不可复性和可复性腹疝修补术患者的特征。其二，比较并发症发生率。其三，确定哪些因素，包括不可复性，可能与复发相关。
这项观察性研究是对252例连续性腹疝患者进行的回顾性分析，分为两个队列：101例接受不可复性腹疝修补术的患者和152例接受可复性腹疝修补术的患者。两组的平均随访时间均约为4年。
接受不可复性疝修补术的患者中位BMI较高（31 vs. 27 kg/m²，p = 0.005），疝存在时间更长（中位34个月对比12个月，p = 0.043），平均缺损更多（均值1.8对比1.4，p < 0.001），且更可能有症状（83%对比55%，p = 0.002）。有趣的是，两组之间疝大小（p = 0.821）和疝位置（p = 0.261）均无显著差异。包括手术部位感染、梗阻和复发率在内的并发症发生率无显著差异；无复发生存率（RFS）分布也无差异。多因素分析中疝复发的危险因素包括修补的疝本身为复发性（HR = 2.06，95%CI = 1.07 - 3.99，p = 0.031）、术后手术部位感染的发生（HR = 5.10，95%CI = 2.18 - 11.91，p < 0.001）以及术后肠梗阻的发生（HR = 5.18，95%CI = 1.82 - 14.75，p = 0.002）。不可复性不是复发的显著预测因素（p = 0.152）。
尽管特征不同，但这两种类型疝的患者在并发症方面无统计学显著差异。未观察到复发与不可复性相关，但发现与其他术后并发症相关。
