Digestive Disease Center, Bispebjerg Hospital, Bispebjerg Bakke 23, 2400, Copenhagen, NV, Denmark.
Hernia. 2021 Jun;25(3):649-654. doi: 10.1007/s10029-020-02312-5. Epub 2020 Sep 25.
Patients scheduled for stoma closure may also have an incisional hernia. Studies have reported acceptable outcomes after contaminated ventral hernia repair, but whether stoma closure and incisional hernia repair should be performed as a combined procedure is unknown. This study examined combined stoma closure and incisional hernia repair compared with incisional hernia repair only.
This was a nationwide propensity-score matched study. Patients who underwent elective incisional hernia repair from 2007-2017 were identified in the Danish Hernia Database. All patients who underwent concurrent stoma closure were matched 1:3 with patients who underwent incisional hernia repair only. The primary outcome was reoperation for hernia recurrence, whereas secondary outcomes included anastomotic leakage, length of hospital stay, and 30-day reoperation and readmission rates.
In total, 516 patients were included. The risk of reoperation for recurrence was increased after concurrent stoma closure compared with incisional hernia repair only (hazard ratio 1.69, 95% confidence interval 1.01-2.82, p = 0.044). Seven (5.4%) patients who underwent incisional hernia repair concurrent to stoma closure were reoperated for anastomotic leakage. Length of hospital stay and reoperation rates within 30 days were increased after concurrent stoma closure compared with incisional hernia repair only (median 8 versus 3 days, p < 0.001 and 29.5% versus 18.6%, p = 0.013), whereas there was no difference in 30-day readmission rates (p = 0.251).
Stoma closure and incisional hernia repair should be performed as a dual-stage procedure to decrease the risk of hernia recurrence.
接受造口关闭术的患者也可能患有切口疝。研究报告了污染性腹疝修补术后可接受的结果，但尚不清楚造口关闭术和切口疝修补术是否应作为联合手术进行。本研究比较了联合造口关闭术和切口疝修补术与单纯切口疝修补术。
这是一项全国性倾向评分匹配研究。在丹麦疝数据库中确定了 2007 年至 2017 年期间接受择期切口疝修补术的患者。所有接受同期造口关闭术的患者与仅接受切口疝修补术的患者按 1:3 进行匹配。主要结果是疝复发的再次手术，次要结果包括吻合口漏、住院时间和 30 天再次手术和再入院率。
共纳入 516 例患者。与单纯切口疝修补术相比，同期行造口关闭术增加了疝复发的再次手术风险（风险比 1.69，95%置信区间 1.01-2.82，p=0.044）。有 7 例（5.4%）同期行造口关闭术和切口疝修补术的患者因吻合口漏而再次手术。与单纯切口疝修补术相比，同期行造口关闭术的患者住院时间和 30 天内再次手术率增加（中位数 8 天比 3 天，p<0.001 和 29.5%比 18.6%，p=0.013），但 30 天内再入院率无差异（p=0.251）。
造口关闭术和切口疝修补术应作为双阶段手术进行，以降低疝复发的风险。
