Department of General Surgery, Heilig-Hart Hospital, Mechelsestraat 24, Lier, Belgium.
StatUa Center for Statistics, University of Antwerp, Wilrijk, Antwerp, Belgium.
Langenbecks Arch Surg. 2021 Feb;406(1):209-218. doi: 10.1007/s00423-020-01898-9. Epub 2020 May 31.
Laparoscopic primary or incisional abdominal hernia repair with intraperitoneal mesh placement is a well-accepted and safe technique. Evidence for complications however remains inconclusive, and little is known about the occurrence of postoperative ileus secondary to postoperative intra-abdominal adhesions with different types of IPOM meshes used. Therefore, we retrospectively compared the occurrence of postoperative ileus between two of the different meshes used in our center.
Three hundred seventy-five patients who underwent ventral hernia repair with intraperitoneal mesh placement, either with a DynaMesh®-IPOM (FEG Textiltechnik mbH, Aachen, Nordrhein-Westfalen, Germany) or a Parietex™ Composite mesh (Medtronic, Minneapolis, MN, USA), at the Heilig-Hart Hospital in Lier (Antwerp, Belgium) between 2012 and 2017 were retrospectively compared with regard to the occurrence of postoperative ileus until 6 weeks postoperatively. Baseline demographics and clinical data up to 6 weeks postoperatively of the patients in the two mesh groups are provided.
The DynaMesh®-IPOM mesh group was associated with a significantly higher incidence of postoperative ileus compared with the Parietex™ Composite mesh group with a cutoff limit at postoperative day 1 (n = 17, 6.8% vs. n = 0, 0.0%; P = 0.003) and postoperative day 4 (n = 13, 5.2% vs. n = 0, 0.0%, P = 0.006), even with a mesh surface area of ≤ 300 cm and when both meshes were fixated with the same method of fixation (Securestrap™) with a cutoff limit for postoperative ileus at postoperative day 1 (n = 4, 7.7% vs. n = 0, 0.0%; P = 0.013) and postoperative day 4 (n = 3, 5.8% vs. n = 0, 0.0%, P = 0.040). Of the 17 patients with a postoperative ileus, 9 (52.9%) had a suspicion of adhesive small bowel obstruction on CT scan (P = 0.033) with definitive confirmation of small bowel adhesions with the DynaMesh®-IPOM mesh at laparoscopy in 2 patients.
Our results confirm current literature available regarding postoperative ileus secondary to postoperative intra-abdominal adhesions with the DynaMesh®-IPOM mesh. However, further research with well-designed, multicenter randomized controlled studies to evaluate the use and related complications of these meshes is needed.
腹腔镜下原发性或切口疝修补术联合腹腔内补片放置是一种被广泛接受且安全的技术。然而，关于术后并发症的证据仍不明确，并且对于使用不同类型的 IPOM 补片导致的术后腹腔内粘连引起的术后肠梗阻知之甚少。因此，我们回顾性比较了我院使用的两种不同补片中术后肠梗阻的发生情况。
回顾性比较 2012 年至 2017 年间在比利时安特卫普 Heilig-Hart 医院接受腹腔镜下腹膜前疝修补术联合腹腔内补片放置的 375 例患者，分别使用 Dynamesh®-IPOM（FEG Textiltechnik mbH，德国北莱茵-威斯特法伦州亚琛）或 Parietex™复合补片（美敦力，明尼苏达州明尼阿波利斯）。比较两组患者术后 6 周内发生术后肠梗阻的情况。提供两组患者的基础人口统计学和临床数据至术后 6 周。
与 Parietex™复合补片组相比，Dynamesh®-IPOM 补片组术后肠梗阻的发生率显著更高，术后第 1 天（n=17，6.8%比 n=0，0.0%；P=0.003）和术后第 4 天（n=13，5.2%比 n=0，0.0%；P=0.006）的差异具有统计学意义，即使补片表面积≤300cm2，且两种补片均采用相同的固定方法（Securestrap™）固定，术后第 1 天（n=4，7.7%比 n=0，0.0%；P=0.013）和术后第 4 天（n=3，5.8%比 n=0，0.0%；P=0.040）的差异也具有统计学意义。17 例术后肠梗阻患者中，9 例（52.9%）CT 扫描提示疑似粘连性小肠梗阻（P=0.033），其中 2 例腹腔镜下证实 Dynamesh®-IPOM 补片导致小肠粘连。
我们的结果证实了目前关于 Dynamesh®-IPOM 补片引起的术后腹腔内粘连导致术后肠梗阻的文献报道。然而，需要进一步进行设计良好的多中心随机对照研究，以评估这些补片的使用情况和相关并发症。
