Pezeshk Ronnie A, Pulikkottil Benson J, Mapula Steven, Schaffer Nathaniel E, Yap Lori, Scott Kelly, Gordon Patricia, Hoxworth Ronald E
Dallas, Texas From the Department of Plastic Surgery, University of Texas Southwestern Medical Center.
Plast Reconstr Surg. 2015 Sep;136(3):362e-369e. doi: 10.1097/PRS.0000000000001532.
Abdominal wall defects remain a significant cause of morbidity and mortality in the United States. Postoperative rehabilitation programs have been used consistently in many surgical subspecialties with exceptional results. Such programs have proven to decrease the total time patients require to resume daily activities. The authors describe a systematic rehabilitation protocol developed with the physical medicine and rehabilitation department that has significantly decreased recurrence rates in patients undergoing complex abdominal wall reconstruction.
A retrospective analysis was carried out on patients presenting for open repair of an abdominal wall defect performed by a single surgeon. Over a 5-year period, there were 275 consecutive patients divided into two similar groups: one group consisted of 137 patients that received abdominal wall rehabilitation; a second group of 138 patients did not. Patient demographics including body mass index, number of hernia defects, number of previous repairs/abdominal operations, defect size, operative time, blood loss, and postoperative complications including recurrence were collected.
Patients enrolled in the abdominal wall rehabilitation program were found to have fewer recurrences at follow-up, with statistical significance compared with those that were not enrolled in the program.
The implementation of the abdominal wall rehabilitation program has resulted in a decrease in recurrence rates following complex abdominal wall hernia repair and reconstruction. This is an innovative system that uses rehabilitation and physical therapy to enhance the psychosocial and occupational status of patients by improving recurrence rates.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在美国，腹壁缺损仍然是发病和死亡的一个重要原因。术后康复计划已在许多外科亚专业中持续使用，并取得了显著成效。这些计划已证明可减少患者恢复日常活动所需的总时间。作者描述了一种与物理医学与康复科共同制定的系统康复方案，该方案显著降低了接受复杂腹壁重建患者的复发率。
对由一名外科医生进行腹壁缺损开放修复的患者进行回顾性分析。在5年期间，共有275例连续患者被分为两个相似的组：一组由137例接受腹壁康复的患者组成；另一组138例患者未接受康复。收集患者的人口统计学数据，包括体重指数、疝缺损数量、既往修复/腹部手术次数、缺损大小、手术时间、失血量以及术后并发症（包括复发）。
发现参加腹壁康复计划的患者在随访时复发较少，与未参加该计划的患者相比具有统计学意义。
腹壁康复计划的实施导致复杂腹壁疝修复和重建后的复发率降低。这是一个创新系统，通过提高复发率，利用康复和物理治疗来提升患者的心理社会和职业状况。
临床问题/证据水平：治疗性，Ⅲ级。
