Department of Surgery, Amsterdam University Medical Centres, University of Amsterdam, G4-133, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
Department of Colorectal Surgery, St Marks Hospital, Academic Institute London, London, UK.
Hernia. 2020 Jun;24(3):459-468. doi: 10.1007/s10029-020-02124-7. Epub 2020 Feb 20.
Complex abdominal wall repair (CAWR) in a contaminated operative field is a challenge. Available literature regarding long-term outcomes of CAWR comprises studies that often have small numbers and heterogeneous patient populations. This study aims to assess long-term outcomes of modified-ventral hernia working group (VHWG) grade 3 repairs. Because the relevance of hernia recurrence (HR) as the primary outcome for this patient group is contentious, the need for further hernia surgery (FHS) was also assessed in relation to long-term survival.
A retrospective cohort study with a single prospective follow-up time-point nested in a consecutive series of patients undergoing CAWR in two European national intestinal failure centers.
In long-term analysis, 266 modified VHWG grade 3 procedures were included. The overall HR rate was 32.3%. The HR rates for non-crosslinked biologic meshes and synthetic meshes when fascial closure was achieved were 20.3% and 30.6%, respectively. The rates of FHS were 7.2% and 16.7%, and occurred only within the first 3 years. Bridged repairs showed poorer results (fascial closure 22.9% hernia recurrence vs bridged 57.1% recurrence). Overall survival was relatively good with 80% en 70% of the patients still alive after 5 and 10 years, respectively. In total 86.6% of the patients remained free of FHS.
In this study of contaminated CAWR, non-crosslinked biologic mesh shows better results than synthetic mesh. Bridging repairs with no posterior and/or anterior fascial closure have a higher recurrence rate. The overall survival was good and the majority of patients remained free of additional hernia surgery.
污染手术部位的复杂腹壁修复（CAWR）是一项挑战。关于 CAWR 长期结果的现有文献包括数量较小且患者人群异质性较大的研究。本研究旨在评估改良腹疝工作组（VHWG）3 级修复的长期结果。由于疝复发（HR）作为该患者群体的主要结果存在争议，因此还评估了进一步疝手术（FHS）与长期生存的关系。
这是一项在两个欧洲国家肠衰竭中心连续系列接受 CAWR 的患者中嵌套的前瞻性随访时间点的回顾性队列研究。
在长期分析中，纳入了 266 例改良 VHWG 3 级手术。总体 HR 率为 32.3%。当筋膜闭合时，非交联生物网和合成网的 HR 率分别为 20.3%和 30.6%。FHS 的发生率分别为 7.2%和 16.7%，且仅发生在最初 3 年内。桥接修复的结果较差（筋膜闭合 22.9%疝复发，桥接 57.1%复发）。总体生存率相对较好，分别有 80%和 70%的患者在 5 年和 10 年后仍然存活。总共有 86.6%的患者免于 FHS。
在这项污染性 CAWR 的研究中，非交联生物网的结果优于合成网。没有后腹壁和/或前腹壁闭合的桥接修复有更高的复发率。总体生存率良好，大多数患者无需进行额外的疝手术。
