Department of Surgery, CH wapi, 9 Avenue Delmée, 7500, Tournai, Belgium.
Surg Endosc. 2017 Sep;31(9):3656-3663. doi: 10.1007/s00464-016-5401-0. Epub 2017 Jan 11.
To assess the long-term incidence and predictive factors for recurrence after laparoscopic ventral hernia repair using a bridging technique.
The study group consisted of 213 consecutive patients operated by laparoscopy for primary ventral (n = 158) or incisional hernia (n = 55) between 2001 and 2014. Patients had a repair without fascia closure by intra-peritoneal onlay placement of a Parietex composite mesh centred on the defect with an overlap of at least 3 cm. Clinical outcome was assessed by a combination of office consultation, patient's electronic medical file review and telephone interview.
There were 144 men and 69 women with a mean age of 55 ± 12 years and a BMI of 32 ± 6. With a mean follow-up of 69 ± 44 months, a recurrent hernia was noted in 16 patients (7.5%). Univariate analysis showed a statistically significant higher recurrence rate in the following conditions: incisional hernia (15%), BMI ≥ 35 (21%), defect width >4 cm (27%), defect area >20 cm (27%), mesh overlap <5 cm (32%) and ratio of mesh area to defect area (M/D ratio) ≤12 (48%). Multivariate logistic analysis revealed that M/D ratio was the only independent predictive factor for recurrence (coefficient -0.79, OR 0.46, p < 0.002). With a M/D ratio ≤8, between 9 and 12, between 13 and 16, and ≥17, the recurrence rate was, respectively, 70, 35, 9 and 0% (p < 0.001).
In laparoscopic repair of ventral hernia using a bridging technique, an overlap of at least 5 cm is not all that is required to prevent hernia recurrence. The M/D ratio is the most important predictive factor for recurrence. A ratio of 13 appears as the threshold under which that technique cannot be recommended and 16 as the threshold over which the risk of recurrence is virtually nil. If a satisfactory M/D ratio cannot be achieved, other surgical repair should be proposed to the patient.
评估使用桥接技术行腹腔镜下腹壁疝修补术后的长期复发率及其预测因素。
研究组纳入了 2001 年至 2014 年间因原发性腹壁（n=158）或切口疝（n=55）行腹腔镜手术的 213 例连续患者。所有患者均接受了一种无筋膜关闭的修补术，即通过腹腔内置入 Parietex 复合网片，将其置于缺损中心，重叠至少 3cm。通过联合门诊就诊、患者电子病历回顾和电话访谈评估临床结果。
患者中有 144 名男性和 69 名女性，平均年龄为 55±12 岁，BMI 为 32±6。平均随访 69±44 个月后，16 例（7.5%）患者出现复发性疝。单因素分析显示，以下情况下的复发率有统计学显著升高：切口疝（15%）、BMI≥35（21%）、缺损宽度＞4cm（27%）、缺损面积＞20cm（27%）、网片重叠＜5cm（32%）和网片面积与缺损面积比（M/D 比）≤12（48%）。多因素逻辑分析显示，M/D 比是唯一的独立复发预测因素（系数-0.79，OR 0.46，p＜0.002）。当 M/D 比≤8、9-12、13-16 和≥17 时，复发率分别为 70%、35%、9%和 0%（p＜0.001）。
在使用桥接技术行腹腔镜下腹壁疝修补术中，至少 5cm 的重叠并不足以预防疝复发。M/D 比是复发的最重要预测因素。13 似乎是该技术不能推荐的阈值，16 是复发风险几乎为零的阈值。如果无法达到满意的 M/D 比，则应向患者提出其他手术修复方案。
