University of California, Los Angeles, CA.
Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
J Am Coll Surg. 2019 May;228(5):776-781. doi: 10.1016/j.jamcollsurg.2019.02.038. Epub 2019 Feb 15.
Hernia mesh removal is growing in demand. Meanwhile, there is no standard for handling the mesh specimen or any consensus on the clinical value of the surgical pathology findings.
All hernia mesh specimens gathered from 2013 to 2018 were analyzed. Patients were categorized based on indication for mesh removal. The "mesh reaction" group included those with clinical reaction deemed to be related to the mesh material. The "mesh nonreaction" group included patients who had mesh removed for a clinical indication unrelated to the mesh material.
One hundred and one patients had 115 mesh specimens that were microscopically evaluated. Patients with clinical diagnosis of mesh reaction were significantly younger (39 vs 56 years; p = 0.023) and more likely to be female (71% vs 39%; p < 0.001) than those without mesh reaction. Although the clinical symptoms were significantly different, the pathology findings were quite similar.
There is no clinical value in submitting mesh specimens for microscopic surgical pathology evaluation, regardless of clinical indication for the mesh removal. Also, no clinical claims can be made based on pathology findings from explanted mesh. In addition, microscopic evaluation does incur additional costs to the consumer. We recommend explanted mesh be submitted for gross examination only for documentation purposes in the medical records.
疝修补网片移除的需求日益增长。与此同时，目前还没有针对网片标本处理的标准，也没有就手术病理结果的临床价值达成共识。
对 2013 年至 2018 年间收集的所有疝修补网片标本进行了分析。根据网片移除的指征对患者进行分类。“网片反应”组包括那些被认为与网片材料有关的临床反应的患者。“网片无反应”组包括因与网片材料无关的临床指征而移除网片的患者。
101 名患者的 115 个网片标本进行了显微镜评估。有临床诊断为网片反应的患者明显更年轻（39 岁 vs 56 岁；p=0.023），且更可能为女性（71% vs 39%；p<0.001）。尽管临床症状明显不同，但病理发现非常相似。
无论网片移除的临床指征如何，提交网片标本进行显微镜外科病理学评估均无临床价值。此外，不能根据取出的网片的病理结果做出任何临床结论。此外，显微镜评估会给消费者带来额外的成本。我们建议仅出于医疗记录中的记录目的，将取出的网片送检进行大体检查。
