Department of Surgery, Erasmus University Medical Center, Room Ee-173, Wytemaweg 80, NL-3015 CN, Rotterdam, The Netherlands.
Department of Radiology, Haga Teaching Hospital, The Hague, The Netherlands.
Langenbecks Arch Surg. 2020 May;405(3):345-352. doi: 10.1007/s00423-020-01881-4. Epub 2020 Apr 22.
Complex abdominal wall hernia repair (CAWHR) is a challenging procedure. Mesh prosthesis is indicated, but the use of synthetic mesh in a contaminated area may add to overall morbidity. Biological meshes may provide a solution, but little is known about long-term results. The aim of our study was to evaluate clinical efficacy and patient satisfaction following Strattice™ (PADM) placement.
In this cohort study, all patients operated for CAWHR with PADM in three large community hospitals in Germany were included. Patients underwent abdominal examination, an ultrasound was performed, and patients completed quality-of-life questionnaires. The study was registered in ClinicalTrials.gov under Identifier NCT02168231.
Twenty-seven patients were assessed (14 male, age 67.5 years, follow-up 42.4 months). The most frequent postoperative complication was wound infection (39.1%). In no case, the PADM had to be removed. Four patients had passed away. During outpatient clinic visit, six out of 23 patients (26.1%) had a recurrence of hernia, one patient had undergone reoperation. Five patients (21.7%) had bulging of the abdominal wall. Quality-of-life questionnaires revealed that patients judged their scar with a median 3.5 out of 10 points (0 = best) and judged their restrictions during daily activities with a median of 0 out of 10.0 (0 = no restriction).
Despite a high rate of wound infection, no biological mesh had to be removed. In some cases, therefore, the biological meshes provided a safe way out of desperate clinical situations. Both the recurrence rate and the amount of bulging are high (failure rate 47.8%). The reported quality of life is good after repair of these complex hernias.
复杂腹壁疝修补术（CAWHR）是一项具有挑战性的手术。需要使用补片，但在污染区域使用合成补片可能会增加整体发病率。生物补片可能是一种解决方案，但对其长期结果知之甚少。本研究旨在评估 Strattice™（PADM）置入后的临床疗效和患者满意度。
在这项队列研究中，纳入了在德国三家大型社区医院接受 PADM 治疗 CAWHR 的所有患者。患者接受腹部检查、超声检查，并完成生活质量问卷。该研究在 ClinicalTrials.gov 上注册，标识符为 NCT02168231。
共评估了 27 例患者（14 例男性，年龄 67.5 岁，随访时间 42.4 个月）。最常见的术后并发症是伤口感染（39.1%）。在任何情况下，都无需取出 PADM。有 4 例患者死亡。在门诊就诊时，23 例患者中有 6 例（26.1%）出现疝复发，1 例患者再次手术。5 例患者（21.7%）出现腹壁膨出。生活质量问卷显示，患者对其疤痕的评分中位数为 3.5 分（满分 10 分），对日常活动受限的评分中位数为 0 分（满分 10 分）。
尽管伤口感染率较高，但没有生物补片需要取出。因此，在某些情况下，生物补片为摆脱绝望的临床情况提供了一种安全的方法。复发率和膨出量均较高（失败率为 47.8%）。修复这些复杂疝后报告的生活质量良好。
