Oma E, Pilsgaard B, Jorgensen L N
Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen NV, Denmark.
Hernia. 2018 Apr;22(2):371-377. doi: 10.1007/s10029-017-1721-9. Epub 2018 Jan 3.
Different techniques and mesh materials are used in parastomal hernia repair with recently reported recurrence rates ranging from 10 to 28%. The aim of this cohort study was to examine the risk of recurrence and chronic pain after Sugarbaker or keyhole parastomal hernia repair with intraperitoneal placement of a polyester monofilament macroporous composite mesh.
Data on all patients undergoing parastomal hernia repair with Parietex™ Composite Parastomal Mesh at our institution during a 4-year period were examined. Patients with urostomy were excluded. A team of three experienced surgeons performed all repairs. Follow-up including physical examination was done after 10 days, 6 and 12 months, and hereafter as annual structured telephone interviews. Patients suspected of hernia recurrence were offered computed tomography scan. Chronic pain was defined as pain requiring out-patient visit(s) and/or regular use of analgesics.
79 patients (Sugarbaker, n = 69; keyhole, n = 10) were included. Of those, 72 procedures were performed laparoscopically and seven by open technique. Two patients were reoperated within 30 days with removal of the mesh. In total, seven (9%) patients had parastomal hernia recurrence (reoperation, n = 3; conservative management, n = 4) during follow-up of median 12 months (range 0-49 months). In univariable logistic analyses, type of stoma was associated with recurrence (ileostomy 28% vs colostomy 3%, p = 0.007). Three patients (4%) reported chronic pain.
In this study, we found low rates of recurrence and chronic pain following parastomal hernia repair using intraperitoneal reinforcement with a polyester monofilament composite mesh.
在造口旁疝修补术中使用了不同的技术和补片材料，最近报道的复发率在10%至28%之间。本队列研究的目的是探讨采用Sugarbaker或锁孔技术行造口旁疝修补术并在腹腔内放置聚酯单丝大孔复合补片后复发和慢性疼痛的风险。
对我院在4年期间使用Parietex™复合造口旁补片进行造口旁疝修补的所有患者的数据进行研究。排除行尿流改道术的患者。由三位经验丰富的外科医生组成的团队进行所有修补手术。术后10天、6个月和12个月进行包括体格检查在内的随访，此后通过年度结构化电话访谈进行随访。怀疑疝复发的患者接受计算机断层扫描。慢性疼痛定义为需要门诊就诊和/或定期使用镇痛药的疼痛。
纳入79例患者（Sugarbaker手术69例；锁孔手术10例）。其中，72例手术通过腹腔镜进行，7例采用开放技术。2例患者在30天内再次手术取出补片。在中位12个月（范围0 - 49个月）的随访期间，共有7例（9%）患者出现造口旁疝复发（再次手术3例；保守治疗4例）。在单因素逻辑分析中，造口类型与复发相关（回肠造口术28% vs 结肠造口术3%，p = 0.007）。3例患者（4%）报告有慢性疼痛。
在本研究中，我们发现采用聚酯单丝复合补片腹腔内加固修补造口旁疝后，复发率和慢性疼痛发生率较低。
