Department of General Surgery, Center for Abdominal Core Health, Digestive Disease and Surgery Institute, The Cleveland Clinic Foundation, 9500 Euclid Avenue, A-100, Cleveland, OH, 44195, USA.
Department of General Surgery, University of Texas Medical Branch, 3100 University Boulevard, Galveston, TX, 77555, USA.
Hernia. 2021 Aug;25(4):1013-1020. doi: 10.1007/s10029-020-02347-8. Epub 2021 Jan 2.
An enterocutaneous fistula (ECF) with an associated large hernia defect poses a significant challenge for the reconstructive surgeon. We aim to describe operative details and 30-day outcomes of elective hernia repair with an ECF when performed by surgeons participating in the Abdominal Core Health Quality Collaborative (ACHQC).
Patients undergoing concomitant hernia and ECF elective repair were identified within the ACHQC. Outcomes of interest were operative details and 30-day rates of surgical site infections (SSI), surgical site occurrences requiring procedural intervention (SSOPI), medical complications, and mortality.
170 patients were identified (mean age 60 years, 52.4% females, mean BMI 32.3 kg/m). 106 patients (62%) had small-bowel ECFs, mostly managed with resection without diversion. 30 patients (18%) had colonic ECFs, which were managed with resection without diversion (14%) or resection with diversion (6%). 100 (59%) had a prior mesh in place, which was removed in 90% of patients. Hernias measured 14 cm ± 7 in width, and 68 (40%) had a myofascial release performed (41 TARs). Mesh was placed in 115 cases (68%), 72% as a sublay, and more frequently of biologic (44%) or permanent synthetic (34%) material. 30-day SSI was 18% (37% superficial, 40% deep), and 30-day SSOPI was 21%. 19 patients (11%) were re-operated: 8 (8%) due to a wound complication and 4 (2%) due to a missed enterotomy. Two infected meshes were removed, one biologic and one synthetic.
Surgeons participating in the ACHQC predominantly resect ECFs and repair the associated hernias with sublay mesh with or without a myofascial release. Morbidity remains high, most closely related to wound complications, as such, concomitant definitive repairs should be entertained with caution.
肠皮肤瘘（ECF）伴大疝缺损给重建外科医生带来了重大挑战。我们旨在描述由参与腹部核心健康质量协作（ACHQC）的外科医生进行的 ECF 择期疝修补术的手术细节和 30 天结果。
在 ACHQC 中确定了同时接受疝和 ECF 择期修复的患者。感兴趣的结果是手术细节以及 30 天内手术部位感染（SSI）、需要手术干预的手术部位事件（SSOPI）、医疗并发症和死亡率的发生率。
共确定了 170 例患者（平均年龄 60 岁，52.4%为女性，平均 BMI 为 32.3kg/m）。106 例（62%）患者存在小肠 ECF，主要通过不进行转流的切除来治疗。30 例（18%）患者存在结肠 ECF，其中 14%通过不进行转流的切除进行治疗，6%通过切除加转流进行治疗。100 例（59%）患者有先前放置的网片，其中 90%的患者移除了网片。疝的宽度为 14cm±7cm，68 例（40%）患者进行了筋膜切开术（41 例 TAR）。115 例（68%）患者放置了网片，72%为下置法，更常使用生物（44%）或永久性合成（34%）材料。30 天 SSI 发生率为 18%（37%为浅表性，40%为深部），30 天 SSOPI 发生率为 21%。19 例（11%）患者需要再次手术：8 例（8%）因伤口并发症，4 例（2%）因遗漏肠切开术。有 2 例感染的网片被移除，1 例为生物材料，1 例为合成材料。
参与 ACHQC 的外科医生主要通过切除 ECF 并用下置法网片修复相关疝，可联合或不联合筋膜切开术。发病率仍然很高，与伤口并发症密切相关，因此，应谨慎考虑同时进行确定性修复。
