Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
Department of Plastic Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
J Am Coll Surg. 2019 Sep;229(3):267-276. doi: 10.1016/j.jamcollsurg.2019.03.023. Epub 2019 Apr 16.
Lateral abdominal wall (LAW) myofascial defects are a challenging reconstructive problem, and no consensus exists on their surgical management. We hypothesized that mesh repairs anchored to the nonyielding LAW boundaries (pillar-anchored repairs [PARs]) would provide more durable reconstructions, with lower hernia recurrence and bulge occurrence rates, compared with mesh repairs anchored to the surrounding oblique muscle complexes (direct repairs [DRs]).
We retrospectively reviewed LAW reconstructions at a single center from 2004 to 2010. Patients were divided into 2 groups based on whether they had received a PAR or a DR. The primary outcome measure was hernia recurrence. The secondary outcome measures were surgical site occurrences (SSOs), surgical site infections (SSIs), and reoperations for complications.
We analyzed 106 consecutive patients with LAW reconstructions (PAR, 59 DR, 47). The median follow-up time was 28.1 months (PAR, 24.5 months; DR, 34.5 months). The baseline demographics were similar in the groups. Nineteen hernia recurrences were observed (PAR, 5 [8.5%]; DR, 14 [29.8%]; p = 0.033, log-rank test). The "closure type" (bridged vs reinforced repair), "mesh type" or "defect area" were not associated with hernia recurrence or bulge occurrence. The groups did not differ significantly regarding SSOs, SSIs, or reoperations for complications. In the multivariable Cox proportional regression model, PAR provided a 3.5 times lower risk of hernia recurrence than DR (adjusted hazard ratio, 0.28; 95% CI 0.09 to 0.88; p = 0.03).
The PAR technique is superior to DR for reconstructing LAW defects in order to achieve the lowest hernia recurrence rates in this complex patient population.
侧腹壁（LAW）筋膜缺损是一个具有挑战性的重建问题，目前对于其手术治疗尚无共识。我们假设，与锚定于周围斜肌复合体的网片修复（直接修复[DR]）相比，锚定于无弹性 LAW 边界的网片修复（柱锚定修复[PAR]）将提供更持久的重建，疝复发和膨出发生率更低。
我们回顾性分析了 2004 年至 2010 年在一家中心进行的 LAW 重建。患者根据是否接受 PAR 或 DR 分为两组。主要观察指标为疝复发。次要观察指标为手术部位发生情况（SSO）、手术部位感染（SSI）和并发症的再次手术。
我们分析了 106 例连续接受 LAW 重建的患者（PAR59 例，DR47 例）。中位随访时间为 28.1 个月（PAR24.5 个月，DR34.5 个月）。两组的基线人口统计学特征相似。观察到 19 例疝复发（PAR5 例[8.5%]，DR14 例[29.8%]；p=0.033，对数秩检验）。“闭合类型”（桥接与增强修复）、“网片类型”或“缺损面积”与疝复发或膨出无关。两组在 SSO、SSI 或并发症再次手术方面无显著差异。在多变量 Cox 比例风险回归模型中，PAR 比 DR 疝复发的风险低 3.5 倍（调整后的危险比，0.28；95%可信区间，0.09 至 0.88；p=0.03）。
PAR 技术优于 DR，用于重建 LAW 缺损，以在这一复杂患者群体中获得最低的疝复发率。
