Kadakia Nikita, Mudgway Ross, Vo Jonathan, Vong Vinson, Seto Tiffany, Bortz Pascal, Depew Aron
Surgery, University of California Riverside School of Medicine, Riverside, USA.
General Surgery, Loma Linda University School of Medicine, Loma Linda, USA.
Cureus. 2020 Aug 2;12(8):e9523. doi: 10.7759/cureus.9523.
Ventral hernia repair (VHR) is one of the most common general surgery procedures; however, few studies with long-term follow-up of VHR outcomes exist.
We performed a retrospective review of VHRs performed from 2000 to 2009 at a single institution. Our primary outcome was recurrence, and secondary outcomes were reoperations and complications including seroma, hematomas, abdominal wall abscess, wound infections, and mesh infections.
Our sample population (n=420; mean age 46.3±11.7 years) included 230 females (54.8%), and cases included laparoscopic (n=31; 7.5%), laparoscopic converted to open (n=7; 1.7%), and open (n=373, 90%). As compared to suture repairs, mesh repair was associated with lower rates of complications (25.7% vs 29.5%, p=0.10) and recurrence (12.8% vs 15.2%, p=0.67). Laparoscopic repairs had lower rates of complications than open repairs (25% vs 26.8%; p=0.70) but similar rates of recurrence (13.8% and 13.6%; p=0.53). After logistic regression, obesity, chronic obstructive pulmonary disease, component separation technique, and prolonged operating time (>75th percentile) were associated with increased complications.
Obesity is a modifiable risk factor and must be addressed in patients undergoing VHRs. Mesh repair does not increase the risk of adverse long-term outcomes and may be performed safely in patients undergoing VHR.
腹疝修补术(VHR)是最常见的普通外科手术之一;然而,很少有对VHR结果进行长期随访的研究。
我们对2000年至2009年在单一机构进行的VHR进行了回顾性研究。我们的主要结局是复发,次要结局是再次手术和并发症,包括血清肿、血肿、腹壁脓肿、伤口感染和补片感染。
我们的样本人群(n = 420;平均年龄46.3±11.7岁)包括230名女性(54.8%),病例包括腹腔镜手术(n = 31;7.5%)、腹腔镜中转开腹手术(n = 7;1.7%)和开腹手术(n = 373,90%)。与缝合修补相比,补片修补的并发症发生率(25.7%对29.5%,p = 0.10)和复发率(12.8%对15.2%,p = 0.67)较低。腹腔镜修补的并发症发生率低于开腹修补(25%对26.8%;p = 0.70),但复发率相似(13.8%和13.6%;p = 0.53)。经过逻辑回归分析,肥胖症、慢性阻塞性肺疾病、成分分离技术和手术时间延长(>第75百分位数)与并发症增加相关。
肥胖是一个可改变的风险因素,在接受VHR的患者中必须加以解决。补片修补不会增加长期不良结局的风险,在接受VHR的患者中可以安全进行。