Department of Surgery, Brigham and Women's Hospital, Boston, MA; Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Department of Surgery, Brigham and Women's Hospital, Boston, MA.
Surgery. 2020 Apr;167(4):765-771. doi: 10.1016/j.surg.2020.01.001. Epub 2020 Feb 13.
Recurrence rates after ventral hernia repair vary widely and evidence about risk factors for recurrence are conflicting. There is little evidence for risk factors for long-term recurrence.
Patients who underwent ventral hernia repair at our institution and were captured in the American College of Surgeons-National Surgical Quality Improvement Program database between 2002 and 2015 were included. We reviewed all demographic, procedural, and hernia-specific data.
Six hundred and thirty patients were included for analysis with a median follow-up of 4.9 years (inter-quartile range, 2-7.3 years). By univariate analysis, index hernia repairs were more likely to recur if defect size was ≥4 cm (P = .019), no mesh was used (P = .026), or if the repair was for a recurrent hernia (P = .001). Five-year cumulative incidence of recurrence and reoperation was 24.3% and 16.0%, respectively. Patients with a perioperative surgical site occurrence, which included superficial, deep-incisional, and organ space surgical site infections as well as wound disruption, had a 5-year cumulative incidence of recurrence of 54.9% compared with 22.6% for those without surgical site occurrence. By multivariable analysis, non-primary hernia repair (hazard ratio 1.7, 95% confidence interval 1.2-2.4, P = .005) and any postoperative surgical site occurrence (hazard ratio 1.9, 95% confidence interval 1.1-3.6, P = .02) were the only risk factors predictive of recurrence. Patient body mass index had no independent effect on recurrence.
1 in 4 patients undergoing an open ventral hernia repair will have a recurrence after 5 years, and this risk is doubled among patients who experience any perioperative surgical site occurrence. After controlling for patient comorbidities, including body mass index, hernia size, and mesh position, the most significant risk factor for recurrence after ventral hernia repair was a non-primary hernia and surgical site occurrence.
腹疝修补术后的复发率差异很大，关于复发风险因素的证据存在冲突。关于长期复发的风险因素的证据很少。
纳入 2002 年至 2015 年期间在美国外科医师学院-国家外科质量改进计划数据库中接受腹疝修补术的患者。我们回顾了所有人口统计学、手术和疝特异性数据。
630 例患者纳入分析，中位随访时间为 4.9 年（四分位距，2-7.3 年）。单因素分析显示，如果缺损大小≥4cm（P=0.019）、未使用补片（P=0.026）或修复为复发性疝（P=0.001），则指数疝修复更有可能复发。5 年复发和再次手术的累积发生率分别为 24.3%和 16.0%。发生围手术期手术部位并发症（包括浅表、深部切口和器官间隙手术部位感染以及伤口破裂）的患者，5 年复发累积发生率为 54.9%，而无手术部位并发症的患者为 22.6%。多因素分析显示，非原发性疝修复（危险比 1.7，95%置信区间 1.2-2.4，P=0.005）和任何术后手术部位并发症（危险比 1.9，95%置信区间 1.1-3.6，P=0.02）是复发的唯一预测因素。患者的体重指数对复发没有独立影响。
在接受开放式腹疝修补术的患者中，1/4 的患者在 5 年后会出现复发，而在经历任何围手术期手术部位并发症的患者中，复发风险增加一倍。在控制患者合并症（包括体重指数、疝大小和补片位置）后，腹疝修补术后复发的最重要风险因素是非原发性疝和手术部位并发症。
