From the Department of Surgery, New Hanover Regional Medical Center; and Division of Plastic Surgery, Department of Surgery, University of Pennsylvania.
Plast Reconstr Surg. 2018 Sep;142(3 Suppl):180S-186S. doi: 10.1097/PRS.0000000000004876.
Incisional and parastomal hernias continue to be vexing problems for patients and surgeons. Risk factors are generally patient-related and/or technical in nature, and in some cases, can be altered, resulting in improved outcomes. Improved fascial closure techniques can only partly reduce the risk of incisional hernia formation. Even under optimal circumstances, using time tested closure techniques and materials, the rate remains high, due primarily to factors that are not modifiable or are unidentifiable. In such cases, there may be a beneficial role for prophylactic mesh augmentation (PMA), wherein mesh is implanted at the time of initial surgery or stoma formation. Several high-risk groups that might benefit from PMA have been identified, including patients undergoing open abdominal aneurysm repair or colorectal procedures, obese patients, and patients requiring creation of permanent gastrointestinal or urological stomas. Although the initial results of PMA are promising, the benefits of this strategy must be weighed against potential risks. Outcome measures to assess efficacy should include not only hernia recurrence but also quality of life, surgical-site occurrences, and cost. Further studies are warranted to predict which specific patient populations might benefit most from PMA and to identify ideal mesh materials as well as preferred implantation sites and methods of mesh fixation.
切口疝和造口旁疝仍然是患者和外科医生感到困扰的问题。风险因素通常与患者相关，或具有技术性质，在某些情况下，这些因素可以改变，从而改善结果。改进的筋膜闭合技术只能部分降低切口疝形成的风险。即使在最佳情况下，使用经过时间考验的闭合技术和材料，由于一些不可改变或无法识别的因素，其发生率仍然很高。在这种情况下，预防性网片修补术（PMA）可能会有一定的作用，即在初次手术或造口形成时植入网片。已经确定了几个可能受益于 PMA 的高风险群体，包括接受开放性腹主动脉瘤修复或结直肠手术的患者、肥胖患者以及需要永久性胃肠或泌尿科造口的患者。尽管 PMA 的初步结果很有希望，但必须权衡这种策略的益处与潜在风险。评估疗效的指标不仅应包括疝复发，还应包括生活质量、手术部位并发症和成本。需要进一步的研究来预测哪些特定的患者群体可能最受益于 PMA，并确定理想的网片材料以及首选的植入部位和网片固定方法。
