Giordano Salvatore A, Garvey Patrick B, Baumann Donald P, Liu Jun, Butler Charles E
Houston, Texas.
From the Department of Plastic Surgery, The University of Texas M. D. Anderson Cancer Center.
Plast Reconstr Surg. 2017 May;139(5):1234-1244. doi: 10.1097/PRS.0000000000003264.
BACKGROUND: Obesity and higher body mass index may be associated with higher rates of wound healing complications and hernia recurrence rates following complex abdominal wall reconstruction. The authors hypothesized that higher body mass indexes result in higher rates of postoperative wound healing complications but similar rates of hernia recurrence in abdominal wall reconstruction patients. METHODS: The authors included 511 consecutive patients who underwent abdominal wall reconstruction with underlay mesh. Patients were divided into three groups on the basis of preoperative body mass index: less than 30 kg/m (nonobese), 30 to 34.9 kg/m (class I obesity), and 35 kg/m or greater (class II/III obesity). The authors compared postoperative outcomes among these groups. RESULTS: Class I and class II/III obesity patients had higher surgical-site occurrence rates than nonobese patients (26.4 percent versus 14.9 percent, p = 0.006; and 36.8 percent versus 14.9 percent, p < 0.001, respectively) and higher overall complication rates (37.9 percent versus 24.7 percent, p = 0.007; and 43.4 percent versus 24.7 percent, p < 0.001, respectively). Similarly, obese patients had significantly higher skin dehiscence (19.3 percent versus 7.2 percent, p < 0.001; and 26.5 percent versus 7.2 percent, p < 0.001, respectively) and fat necrosis rates (10.0 percent versus 2.1 percent, p = 0.001; and 11.8 percent versus 2.1 percent, p < 0.001, respectively) than nonobese patients. Obesity class II/III patients had higher infection and seroma rates than nonobese patients (9.6 percent versus 4.3 percent, p = 0.041; and 8.1 percent versus 2.1 percent, p = 0.006, respectively). However, class I and class II/III obesity patients experienced hernia recurrence rates (11.4 percent versus 7.7 percent, p = 0.204; and 10.3 percent versus 7.7 percent, p = 0.381, respectively) and freedom from hernia recurrence (overall log-rank, p = 0.41) similar to those of nonobese patients. CONCLUSION: Hernia recurrence rates do not appear to be affected by obesity on long-term follow-up in abdominal wall reconstruction. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
背景：肥胖和较高的体重指数可能与复杂腹壁重建术后伤口愈合并发症发生率及疝复发率升高有关。作者推测，较高的体重指数会导致腹壁重建患者术后伤口愈合并发症发生率升高，但疝复发率相似。 方法：作者纳入了511例连续接受补片植入腹壁重建术的患者。根据术前体重指数将患者分为三组：小于30kg/m²（非肥胖）、30至34.9kg/m²（I级肥胖）和35kg/m²及以上（II/III级肥胖）。作者比较了这些组之间的术后结果。 结果：I级和II/III级肥胖患者的手术部位发生率高于非肥胖患者（分别为26.4%对14.9%，p = 0.006；36.8%对14.9%，p < 0.001），总体并发症发生率也更高（分别为37.9%对24.7%，p = 0.007；43.4%对24.7%，p < 0.001）。同样，肥胖患者皮肤裂开率（分别为19.3%对7.2%，p < 0.001；26.5%对7.2%，p < 0.001）和脂肪坏死率（分别为10.0%对2.1%，p = 0.001；11.8%对2.1%，p < 0.001）显著高于非肥胖患者。II/III级肥胖患者的感染和血清肿发生率高于非肥胖患者（分别为9.6%对4.3%，p = 0.041；8.1%对2.1%）。然而，I级和II/III级肥胖患者的疝复发率（分别为11.4%对7.7%，p = 0.204；10.3%对7.7%，p = 0.381）和无疝复发率（总体对数秩检验，p = 0.41）与非肥胖患者相似。 结论：在腹壁重建的长期随访中，疝复发率似乎不受肥胖影响。 临床问题/证据水平：风险，II级。
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