University of Kentucky College of Medicine, Lexington, KY, USA.
Division of General Surgery, Department of Surgery, C 222, Chandler Medical Center, University of Kentucky, 800 Rose Street, Lexington, KY, 40536, USA.
Hernia. 2019 Oct;23(5):1003-1008. doi: 10.1007/s10029-019-02026-3. Epub 2019 Aug 30.
Hernia repair for large and complex hernias presents challenges related to the availability of larger mesh sizes. When sizes beyond those manufactured are required, multiple meshes (MM) may be sutured to create a larger graft. With the availability of large polypropylene mesh up to 50 × 50 cm (LM), abdominal wall reconstruction (AWR) may be accomplished with a single mesh. This study evaluates clinical and economic outcomes following AWR with component separation utilizing MM and LM.
A retrospective study was performed with review of health records and cost accounting data. Patients that underwent AWR with LM were case matched 1:1 with patients undergoing MM repair based upon comorbidities, defect size and wound class.
Twenty-four patients underwent AWR with LM. Twenty patients (10F, 10 M) who underwent AWR with LM were matched with 20 MM AWR (11F, 9 M). Age, BMI, ASA 3 + , never smoker, diabetes, and hernia characteristics were similar between LM and MM. Operative cost ($4295 vs $3669, p = 0.127), operative time (259 min vs 243 min, p = 0.817), length of stay (5.5 vs 6.2, p = 0.484), wound complication (30% vs 20%, p = 0.716), infected seroma (5% vs 5%, p = 1), and readmission (5% vs 15%, p = 0.605) were similar between LM and MM, respectively.
This is the first report of patients undergoing AWR with a large 50 × 50 cm prolene mesh. In this small cohort, clinical outcomes were similar between those undergoing repair with multiple sutured mesh sheets and a single large mesh.
对于大型和复杂疝，疝修补术面临着更大网片尺寸可用性的挑战。当需要超出制造尺寸的尺寸时，可能需要缝合多个网片 (MM) 以创建更大的移植物。随着最大可达 50×50cm 的大聚丙烯网片 (LM) 的出现，腹壁重建 (AWR) 可以通过单个网片完成。本研究评估了使用 MM 和 LM 进行分离组件修复后 AWR 的临床和经济结果。
回顾性研究，审查病历和成本核算数据。使用 LM 进行 AWR 的患者根据合并症、缺损大小和伤口分级与接受 MM 修复的患者进行 1:1 病例匹配。
24 名患者接受了 LM 进行 AWR。20 名接受 LM 进行 AWR 的患者（10 名女性，10 名男性）与 20 名接受 MM AWR 的患者（11 名女性，9 名男性）进行了匹配。LM 和 MM 之间的年龄、BMI、ASA 3+、不吸烟者、糖尿病和疝特征相似。手术费用（$4295 比 $3669，p=0.127）、手术时间（259 分钟比 243 分钟，p=0.817）、住院时间（5.5 天比 6.2 天，p=0.484）、伤口并发症（30%比 20%，p=0.716）、感染性血清肿（5%比 5%，p=1）和再入院（5%比 15%，p=0.605）相似。
这是第一个使用大 50×50cm prolene 网片进行 AWR 的患者报告。在这个小队列中，接受多个缝合网片和单个大网片修复的患者的临床结果相似。
