Diamond Shawn, Cryer H Gill
Department of Surgery, Santa Barbara Cottage Hospital, Santa Barbara, California, USA.
Am Surg. 2015 Oct;81(10):955-60.
Grading systems developed by the Ventral Hernia Working Group (VHWG) for complex open abdominal wall reconstruction rely on limited outcomes: surgical site occurrence (SSO) and hernia recurrence. This does not account for the longitudinal restoration of a functional abdominal wall and the ability to correct complications. We performed a single-site, retrospective review of consecutive complex open abdominal wall reconstruction interventions with 24-month minimum follow-up to establish reoperation rates and compare long-term results to the VHWG. About 125 midline hernia repairs (>200 cm(2)) were studied. All had loss of functional domain and 47-month average follow-up. Demographics included: mean age 57 years, 47 per cent male, 63 per cent obese, and 34 per cent with contamination. Rates of SSO per VHWG grade were 9 per cent grade I, 45 per cent grade II, and 55 per cent grade III. Forty-three of 59 patients who developed complications were eventually successful after reoperation leading to an 87 per cent restoration rate. Select factors independently associated with reoperation included biological mesh and clinical history of infection. Although rates of SSO were higher than the VHWG published, we experienced high salvage rates except in patients who underwent biologic repair. We recommend restricted use of biologic mesh in contaminated and clean fields as well as modifications to the VHWG grading and recommendations.
腹疝工作组（VHWG）制定的用于复杂开放性腹壁重建的分级系统所依据的结果有限：手术部位发生率（SSO）和疝复发情况。这并未考虑功能性腹壁的纵向恢复情况以及纠正并发症的能力。我们对连续进行的复杂开放性腹壁重建干预措施进行了单中心回顾性研究，至少随访24个月，以确定再次手术率，并将长期结果与VHWG进行比较。研究了约125例中线疝修补术（>200 cm²）。所有患者均存在功能区域丧失，平均随访47个月。人口统计学数据包括：平均年龄57岁，47%为男性，63%为肥胖患者，34%存在污染情况。根据VHWG分级，SSO发生率分别为：I级9%，II级45%，III级55%。59例出现并发症的患者中，43例在再次手术后最终成功，恢复率达87%。与再次手术独立相关的选择因素包括生物补片和感染临床病史。尽管SSO发生率高于VHWG公布的数据，但除接受生物补片修复的患者外，我们的挽救率较高。我们建议在污染和清洁手术区域限制使用生物补片，并对VHWG分级和建议进行修改。
