Department of Surgery, University of California, San Francisco, San Francisco, California.
University of California, San Francisco School of Medicine, San Francisco, California.
J Surg Res. 2020 Mar;247:380-386. doi: 10.1016/j.jss.2019.10.005. Epub 2019 Nov 18.
Anterior exposures for lumbar spine surgery are increasingly common for treating various spinal pathologies. A retroperitoneal approach via a paramedian incision has grown rapidly in popularity, but little is known about the risk of incisional hernia development with this technique. We sought to assess the incidence of paramedian incisional hernia development and identify risk factors that are associated with occurrence.
We conducted a retrospective review of all patients who underwent anterior lumbar spine exposure by a paramedian approach between 2012 and 2017 at a single, tertiary medical center. The primary outcome was the development of postoperative paramedian incisional hernia.
Of the 735 patients included in the study, 445 (60.5%) were women, and the mean (standard deviation) age of all patients was 60 y (12.4). Nearly all (97.4%) paramedian approaches were performed with a vascular surgeon present. Median follow-up time was 10 mo (interquartile range 3.5-19.9). Postoperative paramedian hernia developed in 20 patients (2.7%), of which 14 underwent repair. The mean (standard deviation) size of the hernia was 13.5 cm (5.5); 9 of 14 (64%) were repaired with synthetic mesh, whereas 3 of 14 (21%) required bowel resection. On multivariate analysis, risk factors associated with hernia development were male gender (0.045), higher American Society of Anesthesiologists class (0.039), history of abdominal surgery (P = 0.013), and postoperative intensive care unit admission (P = 0.02).
A paramedian approach for anterior lumbar spine exposure resulted in a low rate of incisional hernia with minimal morbidity. Surgeons involved in these collaborative procedures should consider the risk factors that predispose patients to develop these hernias.
腰椎手术的前路暴露术越来越常见，用于治疗各种脊柱病变。经旁正中切口的腹膜后入路的应用迅速普及，但对于该技术后发生切口疝的风险知之甚少。我们旨在评估旁正中切口疝的发生，并确定与之相关的危险因素。
我们对 2012 年至 2017 年期间在一家三级医疗中心行前路腰椎暴露术的所有患者进行了回顾性研究，入组标准为采用旁正中入路。主要结局为术后旁正中切口疝的发生。
在纳入的 735 例患者中，445 例（60.5%）为女性，所有患者的平均（标准差）年龄为 60 岁（12.4）。几乎所有（97.4%）的旁正中入路均有血管外科医生在场。中位随访时间为 10 个月（四分位距 3.5-19.9）。20 例（2.7%）患者发生术后旁正中疝，其中 14 例行修补术。疝的平均（标准差）大小为 13.5 cm（5.5）；14 例中有 9 例（64%）采用合成补片修补，14 例中有 3 例（21%）需要肠切除。多变量分析显示，疝发生的危险因素为男性（0.045）、较高的美国麻醉医师协会（ASA）分级（0.039）、腹部手术史（P=0.013）和术后入住重症监护病房（P=0.02）。
前路腰椎暴露术的旁正中入路导致切口疝的发生率较低，且发病率较低。参与这些联合手术的外科医生应考虑导致患者发生这些疝的危险因素。
