van Silfhout L, Leenders L A M, Heisterkamp J, Ibelings M S
Department of Surgery, ETZ, Tilburg, The Netherlands.
Hernia. 2021 Feb;25(1):77-83. doi: 10.1007/s10029-020-02320-5. Epub 2020 Nov 16.
Hernia recurrence rates after incisional hernia repair vary between 8.7 and 32%, depending on multiple factors such as patient characteristics, the use of meshes, surgical technique and the degree of experience of the treating surgeon. Recurrent hernias are considered complex wall hernias, and 20% of all incisional hernia repairs involve a recurrent hernia. The aim of this study was to investigate the outcomes after recurrent incisional hernia repair, in association with surgical technique and body-mass index (BMI).
All patients who had incisional hernia repair between 2013 and 2018 were included. Primary outcome was rate of recurrent incisional hernia after initial hernia repair. Secondary outcomes were complication rate and recurrence rate in association with BMI.
A number of 269 patients were included, of which 75 patients (27.9%) with a recurrent incisional hernia. Recurrent hernia repair was performed in 49 patients, 83.7% underwent open repair. Complication rate for recurrent hernia repair was higher than for the initial incisional hernia repair. Of the 49 patients with recurrent hernia repair, patients with a BMI above 30 had higher complication and recurrence rates compared to patients with BMI below 30. Especially infectious complications were more common in patients with a higher BMI: 23.1% vs. 0% wound infections.
The results from this study show that complication and recurrence rates are increased after recurrent incisional hernia repair, which are further increased by obesity. Only a limited amount of literature is available on this topic, further larger multicenter studies are necessary, until then a patient-specific surgical approach based on the surgeon's expertise is recommended.
切口疝修补术后的疝复发率在8.7%至32%之间，这取决于多种因素，如患者特征、补片的使用、手术技术以及主刀医生的经验程度。复发性疝被视为复杂的腹壁疝，在所有切口疝修补手术中，20%涉及复发性疝。本研究的目的是探讨复发性切口疝修补术后的疗效，以及与手术技术和体重指数（BMI）的关系。
纳入2013年至2018年间所有接受切口疝修补术的患者。主要结局是初次疝修补术后复发性切口疝的发生率。次要结局是与BMI相关的并发症发生率和复发率。
共纳入269例患者，其中75例（27.9%）为复发性切口疝。49例患者接受了复发性疝修补术，83.7%的患者接受了开放修补术。复发性疝修补术的并发症发生率高于初次切口疝修补术。在49例接受复发性疝修补术的患者中，BMI高于30的患者比BMI低于30的患者并发症和复发率更高。尤其是感染性并发症在BMI较高的患者中更为常见：伤口感染率为23.1%，而BMI较低的患者为0%。
本研究结果表明复发性切口疝修补术后并发症和复发率会增加，肥胖会进一步加剧这种情况。关于这一主题的文献有限，有必要开展进一步的大型多中心研究，在此之前，建议根据外科医生的专业知识采取针对患者的手术方法。
