Comprehensive Hernia Center, Digestive Disease and Surgical Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
Department of Surgery, Greenville Health Systems, Greenville, SC, USA.
J Gastrointest Surg. 2017 Dec;21(12):2083-2089. doi: 10.1007/s11605-017-3601-0. Epub 2017 Oct 5.
The use of surgical drains after ventral hernia repair (VHR) remains controversial. Some have concerns of increased infectious complications; others advocate that drains reduce fluid accumulation and surgical site occurrences (SSO). The aim of our study was to investigate the impact of retromuscular drains on SSO following retromuscular VHR with synthetic mesh.
Utilizing the Americas Hernia Society Quality Collaborative, patients between January 2013 and January 2016 undergoing retromuscular VHR with synthetic mesh were assessed for the presence of a drain. Propensity score matched patients (2 drains: 1 no drain) were evaluated for 30-day rates of SSO, surgical site infections (SSI) and SSO requiring procedural intervention (SSOPI).
Five hundred eighty-one patients were identified as having undergone open, retromuscular VHR with synthetic mesh. Four hundred eighty-one patients with drains and 100 without drains. After matching, 300 patients were compared, 200 with drain placement and 100 without. Retromuscular drains were less likely to develop a noninfectious SSO (OR, 0.33). Drain placement was not associated with SSI (OR, 1.30) or SSOPI (OR, 0.94).
Drain placement after retromuscular VHR with synthetic mesh is a common practice. Based on an analysis of early outcomes, surgical drains do not increase the risk of surgical infectious complications, and may be protective against some SSOs, such as seroma formation.
在腹疝修补术后（VHR）使用引流管仍然存在争议。一些人担心增加感染并发症的风险；另一些人则主张引流管可以减少液体积聚和手术部位并发症（SSO）。我们的研究目的是调查在使用合成网片进行后肌膜 VHR 后，后肌膜引流管对 SSO 的影响。
利用美洲疝学会质量协作组织，评估了 2013 年 1 月至 2016 年 1 月期间接受后肌膜 VHR 联合合成网片治疗的患者是否存在引流管。对有（2 个引流管：1 个无引流管）和无引流管的患者进行倾向性评分匹配，评估 30 天 SSO、手术部位感染（SSI）和需要手术干预的 SSO（SSOPI）的发生率。
共确定了 581 例接受开放、后肌膜 VHR 联合合成网片治疗的患者。481 例患者有引流管，100 例患者无引流管。匹配后，比较了 300 例患者，200 例有引流管，100 例无引流管。后肌膜引流管发生非感染性 SSO 的可能性较小（OR，0.33）。引流管的放置与 SSI（OR，1.30）或 SSOPI（OR，0.94）无关。
在后肌膜 VHR 联合合成网片治疗后放置引流管是一种常见的做法。根据早期结果分析，引流管并不会增加手术感染并发症的风险，并且可能对某些 SSO 有保护作用，如血清肿形成。
