Lykke Anna, Andersen Johnny F B, Jorgensen Lars N, Mynster Tommie
Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, DK-2400, Copenhagen, NV, Denmark.
Department of Radiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Langenbecks Arch Surg. 2017 Sep;402(6):949-955. doi: 10.1007/s00423-017-1596-3. Epub 2017 Jun 14.
This study assessed safety and efficacy associated with hernia prophylaxis using a retromuscular slowly resorbable synthetic mesh for stoma reinforcement.
This was a cohort study with a historic reference group. The study took place in a high-volume surgical department. During a 2-year period (July 2012-July 2014), we included 109 patients undergoing emergency surgery with formation of ileostomy or colostomy. All patients received a retromuscular slowly resorbable synthetic mesh (TIGR®, Novus Scientific) at the stoma site. The reference group included 117 patients who underwent emergency stoma formation without a prophylactic mesh in the 2-year period prior to July 2012. The primary endpoint was effect on prevention of parastomal hernia within 1 year. Secondary endpoints were 30-day and 1-year complications including mortality.
The operative field was contaminated or dirty in 48% of the procedures. Operative time was significantly longer in the mesh group. The cumulative incidences of parastomal hernia at 1 year for the control and the mesh group were 8 and 7% (p = 0.424), respectively. The postoperative 30-day and 1-year rate of complications, reoperations and mortality were not different between the two groups. No patients underwent removal of the mesh and no clinical mesh infections were seen.
Use of a resorbable synthetic mesh during emergency ostomy formation showed no significant preventive effect on formation of parastomal hernia after 1 year. Although surgery was often conducted in a severely contaminated field, the procedure was without significantly increased complication rate.
本研究评估了使用肌后可缓慢吸收的合成补片进行造口强化预防疝的安全性和有效性。
这是一项设有历史参照组的队列研究。研究在一个高容量的外科科室进行。在2年期间（2012年7月至2014年7月），我们纳入了109例行急诊手术并形成回肠造口术或结肠造口术的患者。所有患者在造口部位均接受了一块肌后可缓慢吸收的合成补片（TIGR®，诺维斯科学公司）。参照组包括117例在2012年7月之前的2年期间行急诊造口术但未使用预防性补片的患者。主要终点是1年内预防造口旁疝的效果。次要终点是30天和1年的并发症，包括死亡率。
48%的手术中手术区域被污染或为污染伤口。补片组的手术时间明显更长。对照组和补片组1年时造口旁疝的累积发生率分别为8%和7%（p = 0.424）。两组术后30天和1年的并发症、再次手术和死亡率无差异。没有患者取出补片，也未观察到临床补片感染。
在急诊造口形成过程中使用可吸收合成补片在1年后对造口旁疝的形成未显示出显著预防作用。尽管手术常在严重污染的区域进行，但该手术的并发症发生率并未显著增加。
