Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA; Department of Surgery, The University of Arizona, Tucson, AZ, USA.
Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA.
Int J Surg. 2017 Jul;43:26-32. doi: 10.1016/j.ijsu.2017.05.031. Epub 2017 May 16.
Biologic mesh is preferred for repair of complex abdominal wall hernias (CAWHs) in patients at high risk of wound infection. We aimed to identify predictors of adverse outcomes after complex abdominal wall hernia repair (CAWR) using biologic mesh with different placement techniques and under different surgical settings.
A retrospective case series study was conducted on all patients who underwent CAWR with biologic mesh between 2010 and 2015 at a tertiary medical center.
the study population included 140 patients with a mean age of 54 ± 14 years and a median follow up period 8.8 months. Mesh size ranged from 50 to 1225 cm. Ninety percent of patients had undergone previous surgery. Type of surgery was classified as elective in 50.7%, urgent in 24.3% and emergent in 25.0% and a porcine mesh was implanted in 82.9%. The most common mesh placement technique was underlay (70.7%), followed by onlay (16.4%) and bridge (12.9%). Complications included wound complications (30.7%), reoperation (25.9%), hernia recurrence (20.7%), and mesh removal (10.0%). Thirty-two patients (23.0%) were admitted to the ICU and the mean hospital length of stay was 10.8 ± 17.5 days. Age-sex adjusted predictors of recurrence were COPD (OR 4.2; 95%CI 1.003-17.867) and urgent surgery (OR 10.5; 95%CI 1.856-59.469), whereas for reoperation, mesh size (OR 6.8; 95%CI 1.344-34.495) and urgent surgery (OR 5.2; 95%CI 1.353-19.723) were the predictors.
Using biologic mesh, one-quarter and one-fifth of CAWR patients are complicated with reoperation or recurrence, respectively. The operation settings and comorbidity may play a role in these outcomes regardless of the mesh placement techniques.
生物补片在高危感染风险的患者中，更适用于复杂腹壁疝（CAWH）的修复。我们旨在确定不同放置技术和不同手术环境下使用生物补片修复复杂腹壁疝（CAWR）的不良预后预测因素。
回顾性病例系列研究，纳入 2010 年至 2015 年间在三级医疗中心接受生物补片 CAWR 的所有患者。
研究人群包括 140 名患者，平均年龄 54 ± 14 岁，中位随访时间为 8.8 个月。补片大小从 50 到 1225 cm 不等。90%的患者曾接受过手术。手术类型分为择期手术（50.7%）、紧急手术（24.3%）和急诊手术（25.0%），植入的补片为猪皮补片（82.9%）。最常见的补片放置技术为底层（70.7%），其次为上层（16.4%）和桥接（12.9%）。并发症包括伤口并发症（30.7%）、再次手术（25.9%）、疝复发（20.7%）和补片取出（10.0%）。32 名患者（23.0%）被收入 ICU，平均住院时间为 10.8 ± 17.5 天。COPD（比值比 4.2；95%置信区间 1.003-17.867）和紧急手术（比值比 10.5；95%置信区间 1.856-59.469）是复发的年龄性别调整预测因素，而对于再次手术，补片大小（比值比 6.8；95%置信区间 1.344-34.495）和紧急手术（比值比 5.2；95%置信区间 1.353-19.723）是预测因素。
使用生物补片，四分之一和五分之一的 CAWR 患者分别出现再次手术或复发。手术设置和合并症可能在这些结果中发挥作用，而与补片放置技术无关。
