Department of Surgery, Zealand University Hospital, Koege, Denmark.
Department of Surgery, Regional Hospital, Horsens, Denmark.
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa010.
Although laparoscopic repair of incisional hernias decreases the incidence of wound complications compared with open repair, there has been rising concern related to intraperitoneal mesh placement. The aim of this study was to examine outcomes after open or laparoscopic elective incisional hernia mesh repair on a nationwide basis.
This study analysed merged data from the Danish Hernia Database and the National Patient Registry on perioperative information, 90-day readmission, 90-day reoperation for complication, and long-term operation for hernia recurrence among patients who underwent primary repair of an incisional hernia between 2007 and 2018.
A total of 3090 (57.5 per cent) and 2288 (42.5 per cent) patients had surgery by a laparoscopic and open approach respectively. The defect was closed in 865 of 3090 laparoscopic procedures (28.0 per cent). The median follow-up time was 4.0 (i.q.r. 1.8-6.8) years. Rates of readmission (502 of 3090 (16.2 per cent) versus 442 of 2288 (19.3 per cent); P = 0.003) and reoperation for complication (216 of 3090 (7.0 per cent) versus 288 of 2288 (12.5 per cent); P < 0.001) were significantly lower for laparoscopic than open repairs. Reoperation for bowel obstruction or bowel resection was twice as common after laparoscopic repair compared with open repair (20 of 3090 (0.6 per cent) versus 6 of 2288 (0.3 per cent); P = 0.044). Patients were significantly less likely to undergo repair of recurrence following laparoscopic compared with open repair of defect widths 2-6 cm (P = 0.002).
Laparoscopic intraperitoneal mesh repair for incisional hernia should still be considered for fascial defects between 2 and 6 cm, because of decreased rates of early complications and repair of hernia recurrence compared with open repair.
虽然与开放修复相比，腹腔镜修复切口疝可降低伤口并发症的发生率，但与腹腔内补片放置相关的问题日益受到关注。本研究的目的是在全国范围内研究开放或腹腔镜择期切口疝补片修复的结果。
本研究分析了丹麦疝数据库和国家患者登记处 2007 年至 2018 年期间关于围手术期信息、90 天内再入院、90 天内因并发症再次手术以及疝复发的长期手术的数据。这些数据与接受原发性切口疝修复的患者相关。
共有 3090 例（57.5%）和 2288 例（42.5%）患者分别接受了腹腔镜和开放手术。3090 例腹腔镜手术中，有 865 例（28.0%）关闭了缺损。中位随访时间为 4.0（IQR 1.8-6.8）年。再入院率（3090 例中有 502 例（16.2%），2288 例中有 442 例（19.3%）；P=0.003）和并发症再次手术率（3090 例中有 216 例（7.0%），2288 例中有 288 例（12.5%）；P<0.001）腹腔镜修复显著低于开放修复。与开放修复相比，腹腔镜修复后肠阻塞或肠切除术的再手术率高两倍（3090 例中有 20 例（0.6%），2288 例中有 6 例（0.3%）；P=0.044）。与开放修复相比，腹腔镜修复缺损宽度为 2-6cm 的患者疝复发的修复可能性显著降低（P=0.002）。
对于 2-6cm 的筋膜缺损，腹腔镜腹腔内补片修复仍然应考虑，因为与开放修复相比，其早期并发症和疝复发的修复率较低。
