Schaaf Sebastian, Weber Carsten, Güsgen Christoph, Schwab Robert, Willms Arnulf
Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Bundeswehrzentralkrankenhaus Koblenz, Deutschland.
Zentralbl Chir. 2023 Dec;148(6):516-523. doi: 10.1055/a-1346-0274. Epub 2021 Feb 4.
Incision hernias are common complications after abdominal surgery and affect the recommendations on postoperative physical strain, as it is thought that excessively early strain causes incisional hernias. However, there is no evidence to justify this. This study evaluates the effect of postoperative strain on the risk of incisional hernia.
Patients with a laparoscopy (LS) or laparotomy (LT) were asked to complete a questionnaire on postoperative strain, complaints and quality of life. Patients with hernia surgery, or open abdomen therapy for complicated courses (Clavien-Dindo > III) were excluded.
393 patients completed the questionnaire (43.6%). 274 were LS and 128 LT. The incidence of incisional hernias was 5.2% (LS) and 18.0% (LT, p = 0.001). Incisional hernia patients were younger and more commonly males. 30.5% of incisional hernia patients did not return to normal physical strain postoperatively. Abdominal binders did not affect the hernia rate. The incisional hernia patients showed decreased quality of life scores in both mental and physical domains.
Early postoperative physical strain was not a risk factor for incisional hernia development in this study. However, prospective studies are needed to create necessary evidence to recommend earlier postoperative return to normal physical strain.
切口疝是腹部手术后常见的并发症，影响术后身体活动强度的建议，因为人们认为过早活动会导致切口疝。然而，尚无证据支持这一点。本研究评估术后活动对切口疝风险的影响。
要求接受腹腔镜手术（LS）或开腹手术（LT）的患者填写一份关于术后活动、不适症状和生活质量的问卷。排除接受疝修补手术或因复杂病程（Clavien-Dindo分级>Ⅲ级）接受开腹治疗的患者。
393例患者完成了问卷（43.6%）。其中274例行LS手术，128例行LT手术。切口疝的发生率分别为5.2%（LS组）和18.0%（LT组，p = 0.001）。切口疝患者较年轻，男性更为常见。30.5%的切口疝患者术后未恢复至正常身体活动强度。腹带对疝发生率无影响。切口疝患者在心理和生理领域的生活质量评分均降低。
在本研究中，术后早期身体活动不是切口疝发生的危险因素。然而，需要进行前瞻性研究以提供必要证据，从而建议术后更早恢复正常身体活动。
