Department of Plastic& Reconstructive Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX.
Ann Surg. 2022 Nov 1;276(5):e563-e570. doi: 10.1097/SLA.0000000000004454. Epub 2020 Oct 19.
Ventral hernia repair (VHR) is one of the most commonly performed procedures in the United States, but studies assessing the long-term outcomes of VHR using biologic mesh are scarce.
We sought to determine the rates of hernia recurrence (HR) and surgical site occurrences (SSOs) in a large cohort of patients who underwent AWR with biologic mesh.
We conducted a retrospective cohort study of patients who underwent AWR using either porcine ADM (PADM) or bovine ADM (BADM) from 2005 to 2019. We analyzed the full cohort and a subset of our population with minimum long-term follow-up (LTF) of 5 years. The primary outcome measure was HR. Secondary outcomes were SSOs.
We identified a total of 725 AWRs (49.5% PADM, 50.5% BADM). Mean age was 69 ± 11.5 years and mean body mass index was 31 ± 7 kg/m 2 . Forty-two percent of the defects were clean at the time of AWR, 44% were clean-contaminated, and 14% were contaminated/infected. Mean defect size was 180 ± 174 cm 2 , mean mesh size was 414 ± 203 cm 2 . Hernia recurred in 93 patients (13%), with cumulative HR rates of 4.9%, 13.5%, 17.3%, and 18.8% at 1, 3, 5, and 7 years, respectively. There were no differences in HR ( P = 0.83) and SSO ( P = 0.87) between the 2 mesh types. SSOs were identified in 27% of patients. In our LTF group (n = 162), the HR rate was 16%. Obesity, bridged repair, and concurrent stoma presence/creation were independent predictors of HR; component separation was protective against HR.
Despite its use in complex AWR, ADM provides durable long-term outcomes with relatively low recurrence rates.
腹壁疝修补术（VHR）是美国最常见的手术之一，但使用生物补片评估 VHR 长期结果的研究很少。
我们旨在确定在接受 AWR 并使用动物源性移植物（ADM）修补的大量患者中，疝复发（HR）和手术部位事件（SSO）的发生率。
我们对 2005 年至 2019 年期间接受 AWR 且使用猪 ADM（PADM）或牛 ADM（BADM）的患者进行了回顾性队列研究。我们分析了整个队列和我们的一个具有至少 5 年长期随访（LTF）的人群子集。主要结局指标是 HR。次要结局指标是 SSO。
我们共确定了 725 例 AWR（49.5% PADM，50.5% BADM）。平均年龄为 69 ± 11.5 岁，平均体重指数为 31 ± 7 kg/m 2 。42%的缺损在 AWR 时为清洁，44%为清洁污染，14%为污染/感染。平均缺损大小为 180 ± 174 cm 2 ，平均补片大小为 414 ± 203 cm 2 。93 例（13%）患者发生疝复发，1、3、5 和 7 年时累积 HR 率分别为 4.9%、13.5%、17.3%和 18.8%。两种补片类型之间的 HR（P = 0.83）和 SSO（P = 0.87）无差异。27%的患者出现 SSO。在我们的 LTF 组（n = 162）中，HR 率为 16%。肥胖、桥接修复和并存造口术/造口术的存在是 HR 的独立预测因素；组件分离对 HR 有保护作用。
尽管在复杂的 AWR 中使用 ADM，但该方法提供了持久的长期结果，复发率相对较低。
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