Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH.
Comprehensive Hernia Center, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH.
Surgery. 2019 Feb;165(2):398-405. doi: 10.1016/j.surg.2018.08.001. Epub 2018 Sep 12.
Emergent groin hernia repair can be a challenging clinical scenario. We aimed to evaluate the perioperative and long-term outcomes of emergent groin hernia repair at our institution over the last 10 years, with particular interest in surgical approach and mesh use for such cases.
Adult patients who underwent emergent groin hernia repair from 2005-2015 were retrospectively reviewed. Outcomes included surgical site infections, perioperative complications, readmissions, reoperations, mortality, and long-term hernia recurrence. Predictors of surgical site infection and perioperative complications were investigated using multivariate logistic regression.
A total of 257 patients met inclusion criteria (62% males, median age 72). Hernias were most often indirect inguinal (40.9%) and femoral (33.5%), and 45 cases (17.5%) required a bowel resection. Laparoscopic repair was performed in 3 patients (1.2%). Synthetic mesh was placed in 70% of repairs but in only 15% of cases associated with a bowel resection. The medical complications rate was 16.7%; 3.6% had an surgical site infection, and 30-day mortality rate was 3.1%. Older age (odds ratio 1.05) and gross contamination (odds ratio 4.3) were independently associated with complications. Mesh use was not associated with surgical site infection (odds ratio 1.83, P = .49) or perioperative complications (odds ratio 1.02, P = .96). With a median follow-up of 43 months, there were no mesh infections and recurrence rates were similar between mesh and tissue repairs (6.3% vs 6.8%, P = .91).
Emergent groin hernia repair has high rates of morbidity and mortality most closely associated with increasing age and the presence of contamination. Although mesh use appears to be well tolerated when used in the absence of contamination during emergent groin hernia repair, recurrence rates were similar to tissue repairs.
急诊腹股沟疝修补术可能是一个具有挑战性的临床情况。我们旨在评估过去 10 年来我们医院急诊腹股沟疝修补术的围手术期和长期结果，特别关注此类病例的手术入路和网片使用。
回顾性分析 2005 年至 2015 年期间接受急诊腹股沟疝修补术的成年患者。结果包括手术部位感染、围手术期并发症、再入院、再次手术、死亡率和长期疝复发。使用多变量逻辑回归分析手术部位感染和围手术期并发症的预测因素。
共有 257 例患者符合纳入标准（男性占 62%，中位年龄 72 岁）。疝最常见的是间接腹股沟疝（40.9%）和股疝（33.5%），45 例（17.5%）需要肠切除术。3 例（1.2%）患者行腹腔镜修补术。合成网片在 70%的修复中使用，但在与肠切除术相关的病例中仅使用 15%。医疗并发症发生率为 16.7%；3.6%发生手术部位感染，30 天死亡率为 3.1%。年龄较大（优势比 1.05）和严重污染（优势比 4.3）与并发症独立相关。网片的使用与手术部位感染（优势比 1.83，P=0.49）或围手术期并发症（优势比 1.02，P=0.96）无关。中位随访 43 个月，无网片感染，网片修复与组织修复的复发率相似（6.3%比 6.8%，P=0.91）。
急诊腹股沟疝修补术的发病率和死亡率较高，与年龄增长和污染程度密切相关。虽然在急诊腹股沟疝修补术中无污染时使用网片似乎可以很好地耐受，但复发率与组织修复相似。
