Lanier Steven T, Fligor Jennifer E, Miller Kyle R, Dumanian Gregory A
Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Division of Plastic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Surgery. 2016 Dec;160(6):1508-1516. doi: 10.1016/j.surg.2016.07.004. Epub 2016 Aug 18.
Our objective was to determine outcomes for complex ventral hernia repairs in a large cohort of patients utilizing an operative construct employing retrorectus placement of a narrow, macroporous polypropylene mesh with up to 45 suture fixation points for force distribution. No consensus exists on the optimal technique for repair of complex ventral hernias. Current trends emphasize large meshes with wide overlaps and minimal suture fixation, though reported complications and recurrence remain problematic.
A retrospective review was performed for all patients undergoing ventral hernia repair with retrorectus placement of midweight, uncoated, soft polypropylene mesh by a single surgeon (GAD) between the years of 2010 and 2015. Patient characteristics, operative history, operative data, and postoperative course were reviewed.
A total of 101 patients with a mean age of 56 years and a mean body mass index of 29 m/kg (range 18-51 m/kg) underwent hernia repair. Patients had a median of 3 prior abdominal operations (range 0-9), with 44 patients presenting with recurrent hernias. A total of 42 patients were Ventral Hernia Working Group grade 1, 40 grade 2, 17 grade 3, and 2 grade 4. There were no recurrences at a mean follow-up of almost 400 days for the 93 patients with long-term follow-up. The surgical site occurrence rate was 7.9% (3 surgical site infections, 2 seromas, 2 hematomas, and 4 instances of delayed wound healing in 8 patients). One patient required reoperation for hematoma drainage; 5 patients required readmission within 30 days.
An operative construct employing a retrorectus placement of a narrow, macroporous polypropylene mesh with up to 45 suture fixation points for force distribution can achieve significantly better outcomes across a spectrum of Ventral Hernia Working Group grade, risk-stratified patients compared to rates reported in the literature for current strategies that employ wide meshes with minimal fixation.
我们的目标是确定在一大群患者中进行复杂腹疝修补术的结果，这些患者采用的手术方式是将窄的、大孔聚丙烯补片置于腹直肌后，有多达45个缝合固定点用于力的分布。对于复杂腹疝修补的最佳技术尚无共识。当前的趋势强调使用大补片且重叠宽、缝合固定最少，不过报道的并发症和复发问题仍然存在。
对2010年至2015年间由同一位外科医生（GAD）进行腹直肌后置入中等重量、未涂层、柔软聚丙烯补片的腹疝修补术的所有患者进行回顾性研究。回顾了患者特征、手术史、手术数据和术后病程。
共有101例患者接受疝修补术，平均年龄56岁，平均体重指数29m/kg（范围18 - 51m/kg）。患者既往腹部手术的中位数为3次（范围0 - 9次），44例患者为复发性疝。腹疝工作组分级为1级的患者有42例，2级40例，3级17例，4级2例。93例进行长期随访的患者平均随访近400天无复发。手术部位发生率为7.9%（3例手术部位感染、2例血清肿、2例血肿以及8例患者中4例伤口愈合延迟）。1例患者因血肿引流需要再次手术；5例患者在30天内需要再次入院。
与文献报道的采用宽补片且固定最少的当前策略相比，采用将窄的、大孔聚丙烯补片置于腹直肌后并具有多达45个缝合固定点用于力分布的手术方式，在不同腹疝工作组分级、风险分层的患者中可取得显著更好的结果。
