Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
Department of Surgery I - Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstr. 84, 41464, Neuss, Germany.
Hernia. 2021 Feb;25(1):23-31. doi: 10.1007/s10029-020-02143-4. Epub 2020 Feb 25.
In an Expert Consensus guided by systematic review, the panel agreed that for open elective incisional hernia repair, sublay mesh location is preferred, but open intraperitoneal onlay mesh (IPOM) may be useful in certain settings. This analysis of data from the Herniamed Registry aimed to compare the outcomes of open IPOM and sublay technique.
Propensity score matching of 9091 patients with elective incisional hernia repair and with defect width ≥ 4 cm was performed. The following matching variables were selected: age, gender, risk factors, ASA score, preoperative pain, defect size, and defect localization.
For the 1977 patients with open IPOM repair and 7114 patients with sublay repair, n = 1938 (98%) pairs were formed. No differences were seen between the two groups with regard to the intraoperative, postoperative and general complications, complication-related reoperations and recurrences. But significant disadvantages were identified for the open IPOM repair in respect of pain on exertion (17.1% vs. 13.7%; p = 0.007), pain at rest (10.4% vs. 8.3%; p = 0.040) and chronic pain requiring treatment (8.8% vs. 5.8%; p < 0.001), in addition to rates of 3.8%, 1.1% and 1.1%, respectively, occurring in both matched patients. No relationship with tacker mesh fixation was identified. There are only very few reports in the literature with comparable findings.
Compared with sublay repair, open IPOM repair appears to pose a higher risk of chronic pain. This finding concords with the Expert Consensus recommending that incisional hernia should preferably be repaired using the sublay technique.
在一项基于系统评价的专家共识指导下，专家组一致认为，对于开放式择期切口疝修补术，推荐使用下置式补片，但开放式腹腔内上置式补片（IPOM）在某些情况下可能有用。本研究对 Herniamed 注册中心的数据进行了分析，旨在比较开放式 IPOM 和下置式技术的结果。
对 9091 例择期切口疝修补术患者进行倾向评分匹配，纳入标准为缺损宽度≥4cm。选择了以下匹配变量：年龄、性别、危险因素、ASA 评分、术前疼痛、缺损大小和缺损定位。
在 1977 例接受开放式 IPOM 修补术和 7114 例接受下置式修补术的患者中，有 1938 对（98%）患者进行了匹配。两组患者在术中、术后和总体并发症、与并发症相关的再次手术和复发方面无差异。但是，开放式 IPOM 修补术在用力时疼痛（17.1%比 13.7%；p=0.007）、休息时疼痛（10.4%比 8.3%；p=0.040）和需要治疗的慢性疼痛（8.8%比 5.8%；p<0.001）方面存在显著劣势，同时匹配患者中分别有 3.8%、1.1%和 1.1%的患者出现上述情况。与钉合补片固定无关。文献中仅有极少数具有类似发现的报道。
与下置式修补术相比，开放式 IPOM 修补术似乎有更高的慢性疼痛风险。这一发现与专家共识一致，即切口疝应优先采用下置式技术进行修补。
