Digestive Disease Institute, Cleveland Clinic, 9500 Euclid Avenue, A100, Cleveland, OH, 44195, USA.
Fundació Clínic per la Recerca Biomèdica, Hospital Clínic of Barcelona, Universitat de Barcelona, Barcelona, Spain.
Surg Endosc. 2018 Apr;32(4):1820-1827. doi: 10.1007/s00464-017-5866-5. Epub 2017 Sep 20.
This study aims to evaluate the outcomes and utilization of porcine acellular dermal collagen implant (PADCI) during VHR at a large tertiary referral center.
Records of 5485 patients who underwent VIHR from June 1995 to August 2014 were retrospectively reviewed to identify patients >18 years of age who had VIHR with PADCI reinforcement. Use of multiple mesh reinforcement products, inguinal hernias, and hiatal hernias were exclusion criteria. The primary outcome was hernia recurrence, and secondary outcomes were early complications and surgical site occurrences (SSOs). Uni- and multivariate analyses assessed risk factors for recurrence after PADCI reinforced VIHR.
There were 361 patients identified (54.5% female, mean age of 56.7 ± 12.5 years, and mean body mass index (BMI) of 33.0 ± 9.9 kg/m). Hypertension (49.5%), diabetes (24.3%), and coronary artery disease (14.4%) were the most common comorbidities, as was active smoking (20.7%). Most were classified as American Association of Anesthesiologists (ASA) Class 3 (61.7%). Hernias were distributed across all grades of the ventral hernia working group (VHWG) grading system: grade I 93 (25.7%), grade II 51 (14.1%), grade III 113 (31.3%), and grade IV 6 (1.6%). Most VIHR were performed from an open approach (96.1%), and were frequently combined with concomitant surgical procedures (47.9%). Early postoperative complications (first 30 days) were reported in 39.0%, with 71 being SSO. Of the 19.7% of patients with SSO, there were 31 who required procedural intervention. After a mean follow-up of 71.5 ± 20.5 months, hernia recurrence was documented in 34.9% of patients. Age and male gender were predictors of recurrence on multivariate analysis.
To the best of our knowledge, this is the largest retrospective single institutional study evaluating PADCI to date. Hernias repaired with PADCI were frequently in patients undergoing concomitant operations. Reinforcement with PADCI may be considered a temporary closure, with a relatively high recurrence rate, especially among patients who are older, male, and undergo multiple explorations in a short perioperative period.
本研究旨在评估在大型三级转诊中心进行 VHR 时使用猪脱细胞真皮胶原植入物（PADCI）的结果和利用情况。
回顾性分析 1995 年 6 月至 2014 年 8 月期间 5485 例接受 VIHR 的患者记录，以确定年龄>18 岁且接受 VIHR 并使用 PADCI 增强的患者。排除使用多种网片增强产品、腹股沟疝和食管裂孔疝的患者。主要结局是疝复发，次要结局是早期并发症和手术部位事件（SSO）。单因素和多因素分析评估了 PADCI 增强 VIHR 后复发的危险因素。
共确定了 361 例患者（54.5%为女性，平均年龄 56.7±12.5 岁，平均体重指数（BMI）为 33.0±9.9kg/m²）。最常见的合并症是高血压（49.5%）、糖尿病（24.3%）和冠状动脉疾病（14.4%），以及吸烟（20.7%）。大多数患者被归类为美国麻醉医师协会（ASA）分级 3（61.7%）。疝分布在腹疝工作组（VHWG）分级系统的所有等级：I 级 93 例（25.7%），II 级 51 例（14.1%），III 级 113 例（31.3%），IV 级 6 例（1.6%）。大多数 VIHR 是通过开放入路进行的（96.1%），并且经常与同时进行的手术相结合（47.9%）。报告了 39.0%的早期术后并发症（前 30 天），71 例为 SSO。在 19.7%的 SSO 患者中，有 31 例需要进行程序性干预。在平均随访 71.5±20.5 个月后，有 34.9%的患者记录到疝复发。年龄和男性是多因素分析中复发的预测因素。
据我们所知，这是迄今为止最大的回顾性单机构研究，评估了 PADCI 的使用情况。使用 PADCI 修复的疝经常发生在同时进行手术的患者中。用 PADCI 增强可能被认为是一种暂时的关闭，其复发率相对较高，尤其是在年龄较大、男性和在围手术期内进行多次探查的患者中。
