Hoffmann H, Köckerling F, Adolf D, Mayer F, Weyhe D, Reinpold W, Fortelny R, Kirchhoff P
ZweiChirurgen GmbH-Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland.
Hirslanden Clinic Birshof, Hernia Center, Reinacherstrasse 28, 4142, Münchenstein, Switzerland.
Hernia. 2021 Feb;25(1):61-75. doi: 10.1007/s10029-020-02263-x. Epub 2020 Jul 15.
The proportion of recurrences in the total collective of all incisional hernias has been reported to be around 25%. In the European Hernia Society (EHS) classification, recurrent incisional hernias are assigned to a unique prognostic group and considered as complex abdominal wall hernias. Surgical repairs are characterized by dense adhesions, flawed anatomical planes caused by previous dissection or mesh use, and device-related complications. To date, only relatively small case series have been published focusing on outcomes following recurrent incisional hernia repair. This cohort study now analyzes the outcome of recurrent incisional hernia repair assessing potential risk factors based on data from the Herniamed registry. Special attention is paid to the technique used during the primary incisional hernia repair, since laparoscopic IPOM was recently deemed to cause more complications during subsequent repairs.
In the multicenter Internet-based Herniamed registry, patients with recurrent incisional hernia repair between September 2009 and January 2018 were enrolled. In a confirmatory multivariable analysis, factors potentially associated with the outcome parameters (intraoperative, postoperative and general complications, complication-related reoperations, re-recurrences, pain at rest and on exertion, and chronic pain requiring treatment at one-year follow-up) were evaluated.
In total, 4015 patients from 712 participating hospitals were included. Postoperative complications and complication-related reoperations were significantly associated with larger recurrent hernia defect size, open recurrent incisional hernia repair and the use of larger meshes. General complications were more frequent in female sex patients and when larger meshes were used. Higher re-recurrence rate was observed with lateral defect localization, present risk factors, and time interval ≤ 1 year between primary and recurrent incisional hernia repair. Pain rates at 1-year follow-up were unfavorably related with pre-existing preoperative pain, female sex, lateral defect localization, larger mesh, presence of risk factors, and postoperative complications. As regards the primary incisional hernia repair technique, laparoscopic IPOM was found to show no effect versus open mesh techniques on the subsequent recurrence repair, despite a trend toward higher rates of complication-related reoperations.
The outcomes of recurrent incisional hernia repair were significantly associated with potential influencing factors, which are very similar to the factors seen in primary incisional hernia repair. The impact of the primary incisional hernia repair technique, namely laparoscopic IPOM versus open mesh techniques, on the outcome of recurrent incisional hernia repair seems less pronounced than anticipated.
据报道，在所有切口疝患者群体中，复发率约为25%。在欧洲疝学会（EHS）分类中，复发性切口疝被归为一个独特的预后组，并被视为复杂腹壁疝。手术修复的特点是粘连致密、因先前的解剖或使用补片导致解剖层面有缺陷以及与器械相关的并发症。迄今为止，仅有相对较小的病例系列发表，聚焦于复发性切口疝修复后的结果。这项队列研究现基于疝医学注册中心的数据，分析复发性切口疝修复的结果并评估潜在风险因素。特别关注初次切口疝修复时所采用的技术，因为最近认为腹腔镜下腹腔内补片修补术（IPOM）在后续修复中会导致更多并发症。
在基于互联网的多中心疝医学注册中心，纳入2009年9月至2018年1月期间接受复发性切口疝修复的患者。在一项验证性多变量分析中，评估了可能与结果参数（术中、术后及一般并发症、与并发症相关的再次手术、复发、静息和用力时的疼痛以及在一年随访时需要治疗的慢性疼痛）相关的因素。
总共纳入了来自712家参与医院的4015例患者。术后并发症及与并发症相关的再次手术与复发性疝缺损尺寸较大、开放性复发性切口疝修复以及使用较大补片显著相关。一般并发症在女性患者中更常见，且在使用较大补片时更频繁。在疝缺损位于外侧、存在风险因素以及初次与复发性切口疝修复之间的时间间隔≤1年时，观察到更高的复发率。在一年随访时的疼痛发生率与术前已存在的疼痛、女性、疝缺损位于外侧、补片较大、存在风险因素以及术后并发症呈不利相关。至于初次切口疝修复技术，尽管与并发症相关的再次手术率有升高趋势，但发现腹腔镜IPOM与开放性补片技术相比，对后续复发修复无影响。
复发性切口疝修复的结果与潜在影响因素显著相关，这些因素与初次切口疝修复中所见的因素非常相似。初次切口疝修复技术，即腹腔镜IPOM与开放性补片技术，对复发性切口疝修复结果的影响似乎不如预期的那么明显。
