Weltz Adam S, Sibia Udai S, Zahiri H Reza, Schoeneborn Alexa, Park Adrian, Belyansky Igor
Am Surg. 2017 Sep 1;83(9):937-942.
Ideal fixation techniques have not been fully elucidated at the time of complex open abdominal wall reconstruction (AWR). We compared operative outcomes and quality of life with retromuscular mesh fixation using fibrin glue (FG) versus transfascial sutures (TS). Retrospective review identified complex hernia patients who underwent open AWR with mesh from November 2012 through April 2016. Multivariate analysis examined postoperative outcomes between groups. Quality of life was assessed using the Carolinas Comfort Scale. Seventy-five patients (18 FG vs 57 TS) with mean age (54.3 vs 53.9 years, P = 0.914), body mass index (35.8 vs 34.7 kg/m2, P = 0.623) and American Society of Anesthesiologist score (2.6 vs 2.5, P = 0.617) were reviewed. No differences in wound (P = 0.072) and nonwound (P = 0.639) related complications were noted between groups. Risk of reoperations (P = 0.275) and 30-day readmissions (P = 0.137) were also comparable. The TS group was twelve times more likely to report pain at six-month follow-up compared with FG (12.29 OR, 95 per cent confidence interval 1.26-120.35, P = 0.031). No hernia recurrences were noted in either group at a mean follow-up of 390 ± 330 days. The use of FG to secure mesh in the retromuscular space during complex open AWR may be a safe alternative to penetrating transfascial fixation with potential to reduce chronic pain.
在复杂的开放性腹壁重建（AWR）时，理想的固定技术尚未完全阐明。我们比较了使用纤维蛋白胶（FG）与经筋膜缝合（TS）进行肌后补片固定的手术效果和生活质量。回顾性分析确定了2012年11月至2016年4月期间接受开放性AWR并使用补片的复杂疝患者。多变量分析检查了两组之间的术后结果。使用卡罗莱纳舒适度量表评估生活质量。对75例患者（18例使用FG，57例使用TS）进行了回顾，其平均年龄（54.3岁对53.9岁，P = 0.914）、体重指数（35.8kg/m²对34.7kg/m²，P = 0.623）和美国麻醉医师协会评分（2.6对2.5，P = 0.617）。两组之间在伤口相关并发症（P = 0.072）和非伤口相关并发症（P = 0.639）方面未发现差异。再次手术风险（P = 0.275）和30天再入院率（P = 0.137）也具有可比性。与FG组相比，TS组在六个月随访时报告疼痛的可能性高12倍（比值比12.29，95%置信区间1.26 - 120.35，P = 0.031）。在平均390±330天的随访中，两组均未发现疝复发。在复杂的开放性AWR期间，使用FG在肌后间隙固定补片可能是穿透性经筋膜固定的一种安全替代方法，有可能减轻慢性疼痛。
