Kugler Nathan W, Bobbs Melanie, Webb Travis, Carver Thomas W, Milia David, Paul Jasmeet S
Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
Division of Trauma and Critical Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
J Surg Res. 2016 Jul;204(1):200-4. doi: 10.1016/j.jss.2016.04.065. Epub 2016 May 6.
The Modified Hernia Grading System (MHGS) was developed to risk stratify complex ventral hernia repairs (VHRs). MHGS grade 3 patients have mesh infections, dirty or contaminated fields, and/or violation of the alimentary tract. Reported surgical site infection (SSI) rates are over 40% after single-stage VHR in contaminated fields. In an attempt to decrease the SSI rate in MHGS grade 3 patients, we developed a dual-stage VHR (DSVHR) approach.
We reviewed adult general surgery patients undergoing DSVHR between January 2010 and June 2014. All patients were MHGS grade 3. Primary end point was 30-d superficial and deep SSI. Secondary end points included other surgical site occurrences, 6-mo recurrence, and mesh excision rates.
Fifteen patients underwent DSVHR. Mean age was 56 y, and median body mass index was 38.3 kg/m(2). Operative indication included enterocutaneous fistulas (ECF; n = 6), ECF with infected mesh (n = 2), infected mesh (n = 2), and VHR requiring bowel resection (n = 5). Thirty-one operative procedures were performed with median of 2.5 d between procedures. Fascial closure was re-established in 12 patients; five patients had underlay biologic mesh placement; seven underwent component separation with retrorectus mesh placement (synthetic [n = 2], biologic [n = 5]). The remaining patients underwent bridging repair with biologic mesh. One patient developed a recurrence after 6 mo, whereas a single patient had a recurrence of their ECF. Four (27%) patients developed a SSI, with an additional four (27%) experiencing a surgical site occurrence. There were no postoperative mesh infections.
DSVHR in MHGS grade 3 patients is associated with a lower SSI rate than previously reported for those undergoing single-stage repairs.
改良疝分级系统（MHGS）用于对复杂腹疝修补术（VHR）进行风险分层。MHGS 3级患者存在网片感染、术野污染或污秽以及/或者消化道破损情况。据报道，在污染术野进行单阶段VHR后手术部位感染（SSI）率超过40%。为降低MHGS 3级患者的SSI率，我们研发了双阶段VHR（DSVHR）方法。
我们回顾了2010年1月至2014年6月期间接受DSVHR的成年普通外科患者。所有患者均为MHGS 3级。主要终点为30天浅表和深部SSI。次要终点包括其他手术部位事件、6个月复发率和网片切除率。
15例患者接受了DSVHR。平均年龄为56岁，中位体重指数为38.3kg/m²。手术指征包括肠皮肤瘘（ECF；n = 6）、伴有感染网片的ECF（n = 2）、感染网片（n = 2）以及需要肠切除的VHR（n = 5）。共进行了31次手术操作，两次手术之间的中位间隔时间为2.5天。12例患者重新建立了筋膜闭合；5例患者进行了补片植入；7例患者进行了腹直肌后补片植入的成分分离术（合成补片[n = 2]，生物补片[n = 5]）。其余患者采用生物补片进行桥接修复。1例患者在6个月后出现复发，而1例患者的ECF复发。4例（2
