Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, BX 7375 Clinical Science Center - H4, Madison, WI, 53792, USA.
William S. Middleton VA, Madison, WI, USA.
Surg Endosc. 2017 Nov;31(11):4551-4557. doi: 10.1007/s00464-017-5515-z. Epub 2017 Apr 4.
Laparoscopic ventral hernia repair (LVHR) is associated with decreased wound morbidity compared to open repair. It remains unclear whether primary fascial closure (PFC) offers any benefit in reducing postoperative seroma compared to bridged repair. We hypothesized that PFC would have no effect on seroma formation following LVHR.
A retrospective cohort study was performed using data from the prospectively maintained Americas Hernia Society Quality Collaborative. All patients undergoing LVHR from 2013 to 2016 were included. The primary outcome was seroma formation, diagnosed either clinically or radiographically. Secondary outcomes included surgical site infections (SSI), surgical site occurrences (SSO), and SSO requiring intervention. Patient characteristics and outcomes were compared between groups with univariate analysis using Pearson's chi-squared or Wilcoxon tests. Multivariable logistic regression controlling for patient and hernia characteristics was then performed to investigate the independent effect of PFC on seroma formation.
1280 patients were included in the study. 69% (n = 887) underwent PFC. Patients undergoing bridged repairs had slightly larger defects and were more likely to have a recurrent hernia. The overall rate of seroma formation was 10.4% (n = 133). There was no association on univariate analysis between PFC and wound complications. Similarly, on multivariable analysis, PFC had no significant effect on the risk of seroma formation (OR 0.87, 95% CI 0.58-1.31).
PFC does not decrease the risk of short-term wound complications. Given that prior studies have also suggested no difference in hernia recurrence, PFC does not appear to improve postoperative outcomes for patients undergoing LVHR.
与开放式修补相比，腹腔镜下腹疝修补术（LVHR）与减少伤口发病率有关。目前尚不清楚原发性筋膜闭合（PFC）是否在减少术后血清肿方面优于桥接修复。我们假设 PFC 不会对 LVHR 后的血清肿形成产生任何影响。
使用前瞻性维护的美洲疝协会质量协作的数据进行回顾性队列研究。纳入 2013 年至 2016 年间接受 LVHR 的所有患者。主要结局是通过临床或放射学诊断的血清肿形成。次要结局包括手术部位感染（SSI）、手术部位发生（SSO）和需要干预的 SSO。使用 Pearson's chi-squared 或 Wilcoxon 检验对组间患者特征和结局进行单变量分析。然后进行多变量逻辑回归，控制患者和疝特征，以调查 PFC 对血清肿形成的独立影响。
共纳入 1280 例患者。69%（n=887）行 PFC。桥接修复患者的缺损稍大，更有可能患有复发性疝。血清肿形成的总发生率为 10.4%（n=133）。单变量分析显示 PFC 与伤口并发症之间无关联。同样，多变量分析显示，PFC 对血清肿形成的风险无显著影响（OR 0.87，95%CI 0.58-1.31）。
PFC 不会降低短期伤口并发症的风险。鉴于先前的研究也表明疝复发无差异，因此 PFC 似乎不会改善接受 LVHR 的患者的术后结局。
