Fox Sarah S, Janczyk Randy, Warren Jeremy A, Carbonell Alfredo M, Poulose Benjamin K, Rosen Michael J, Hope William W
Am Surg. 2017 Aug 1;83(8):881-886.
The purpose of this review was to evaluate outcomes relating to parastomal hernia repair. Data from the Americas Hernia Society Quality Collaborative were used to identify patients undergoing parastomal hernia repair from 2013 to 2016. Parastomal hernia repairs were compared with other repairs using Pearson's test and Wilcoxon test with a P value <0.05 considered significant. Parastomal hernia repairs were performed in 311 patients. Techniques of repair include open in 85 per cent and laparoscopic in 15 per cent. Mesh was used in 92 per cent with keyhole in 34 per cent, flat mesh in 33 per cent, and Sugarbaker in 25 per cent. Mesh types were permanent synthetic in 79 per cent, biologic in 13 per cent, absorbable synthetic in 6 per cent, and hybrid synthetic/biologic in 2 per cent. Most common location for mesh was sublay in 84 per cent followed by onlay in 14 per cent and inlay in 2 per cent with 59 per cent of patients undergoing a myofascial release. Ostomy disposition included ostomy left in situ (47%), moved to a new site (18%), taken down (22%), and rematured in same location in (13%). Outcomes related to parastomal hernia repair included 10 per cent surgical site infection, 24 per cent surgical site occurrence, and 12 per cent surgical site occurrences requiring procedural interventions with a 13 per cent readmission rate and 6 per cent reoperation rate. When comparing parastomal hernias with other ventral hernia repairs, parastomal hernias had a significantly higher surgical site infection, surgical site occurrence, surgical site occurrences requiring procedural intervention, readmission, reoperation rate, and length of stay, and were less commonly performed laparoscopically (P < 0.05). Most parastomal hernias are being repaired open with synthetic mesh in the sublay position. Less favorable outcomes of parastomal hernia repair when compared with other ventral hernia repairs are likely related to the complexity of parastomal hernia repair.
本综述的目的是评估与造口旁疝修补相关的结果。利用来自美洲疝学会质量协作组的数据，确定2013年至2016年期间接受造口旁疝修补的患者。采用Pearson检验和Wilcoxon检验将造口旁疝修补与其他修补进行比较，P值<0.05被认为具有统计学意义。311例患者接受了造口旁疝修补。修补技术包括85%为开放手术，15%为腹腔镜手术。92%的患者使用了补片，其中34%为匙孔补片，33%为平片补片，25%为Sugarbaker补片。补片类型中，79%为永久性合成补片，13%为生物补片，6%为可吸收合成补片，2%为合成/生物混合补片。补片最常见的放置位置是腹膜前位，占84%，其次是腹膜前位，占14%，嵌入位占2%，59%的患者接受了肌筋膜松解术。造口处置包括造口原位保留（47%）、转移至新位置（18%）、切除（22%）以及在同一位置重新成熟（13%）。与造口旁疝修补相关的结果包括10%的手术部位感染、24%的手术部位并发症以及12%的需要进行手术干预的手术部位并发症，再入院率为13%，再次手术率为6%。与其他腹疝修补相比，造口旁疝的手术部位感染、手术部位并发症、需要手术干预的手术部位并发症、再入院率、再次手术率和住院时间显著更高，且腹腔镜手术的实施频率较低（P<0.05）。大多数造口旁疝采用开放手术并在腹膜前位放置合成补片进行修补。与其他腹疝修补相比，造口旁疝修补的预后较差可能与造口旁疝修补的复杂性有关。
