Cano-Valderrama Oscar, Porrero José L, Quirós Esther, Bonachia Oscar, Castillo María J, Cervantes Norman, Marcos Alberto, Torres Antonio J
Am Surg. 2019 Feb 1;85(2):183-187.
Lately, incisional hernia repair (IHR) with onlay polypropylene mesh has been replaced by other surgical procedures. The aim of this study was to compare the complication and recurrence rate after onlay mesh repair and other surgical procedures for IHR. A retrospective cohort study of patients who underwent IHR in a single center was conducted. The data were obtained from electronic medical records. Patients who had been lost during follow-up were contacted for a visit in the clinic. Univariate and multivariate analysis was performed with Stata 13.0 to analyze the factors associated with postoperative complications and hernia recurrence. Between June 2004 and December 2015, 1078 patients underwent IHR in a single center. Onlay mesh repair was performed in 125 patients (11.6%). Other surgical procedures included Rives procedure (29.3%), sublay mesh repair (38.6%), intrabdominal mesh repair (17.1%), and primary closure (3.4%). After a mean follow-up of 2.8 years, 73 (7%) patients developed a recurrence. A higher percentage of complications were seen after onlay mesh repair than after other surgical procedures (22.4% 13.1%, = 0.005). Nevertheless, recurrence was less frequent after onlay mesh repair (4.2% 7.1%, = 0.241). Logistic regression discarded an association between onlay mesh repair and hernia recurrence or postoperative complications. Incisional hernia repair with onlay polypropylene mesh repair was not associated with a higher incidence of postoperative complications or recurrence rate. So, this procedure should not be discarded in selected patients presenting with incisional hernia.
最近，采用聚丙烯补片修补的切口疝修补术（IHR）已被其他外科手术所取代。本研究的目的是比较聚丙烯补片修补术和其他IHR外科手术术后的并发症及复发率。对在单一中心接受IHR的患者进行了一项回顾性队列研究。数据取自电子病历。对失访患者进行门诊随访。使用Stata 13.0进行单因素和多因素分析，以分析与术后并发症及疝复发相关的因素。2004年6月至2015年12月期间，1078例患者在单一中心接受了IHR。125例患者（11.6%）接受了聚丙烯补片修补术。其他外科手术包括里夫斯手术（29.3%）、腹膜前补片修补术（38.6%）、腹腔内补片修补术（17.1%）和一期缝合（3.4%）。平均随访2.8年后，73例（7%）患者出现复发。聚丙烯补片修补术后出现并发症的比例高于其他外科手术（22.4%对13.1%，P = 0.005）。然而，聚丙烯补片修补术后复发较少见（4.2%对7.1%，P = 0.241）。逻辑回归分析排除了聚丙烯补片修补术与疝复发或术后并发症之间的关联。采用聚丙烯补片修补的切口疝修补术与术后并发症发生率较高或复发率无关。因此，对于某些切口疝患者，不应放弃该手术方法。
