Knaapen L, Buyne O, Slater N, Matthews B, Goor H, Rosman C
Department of Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
Department of Plastic and Reconstructive Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands.
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa057.
The surgical treatment of patients with complex ventral hernias is challenging. The aim of this study was to present an international overview of expert opinions on current practice.
A survey questionnaire was designed to investigate preoperative risk management, surgical approach and mesh choice in patients undergoing complex hernias repair, and treatment strategies for infected meshes. Geographical location of practice, experience and annual volumes of the surgeons were compared.
Of 408 surgeons, 234 (57.4 per cent) were practising in the USA, 116 (28.4 per cent) in Europe, and 58 (14.2 per cent) in other countries. Some 412 of 418 surgeons (98.6 per cent) performed open repair and 322 of 416 (77.4 per cent) performed laparoscopic repair. Most recommended preoperative work-up/lifestyle changes such as smoking cessation (319 of 398, 80.2 per cent) and weight loss (254 of 399, 63.7 per cent), but the consequences of these strategies varied. American surgeons and less experienced surgeons were stricter. Antibiotics were given at least 1 h before surgery by 295 of 414 respondents (71.3 per cent). Synthetic and biological meshes were used equally in contaminated primary hernia repair, whereas for recurrent hernia repair synthetic mesh was used in a clean environment and biological or no mesh in a contaminated environment. American surgeons and surgeons with less experience preferred biological mesh in contaminated environments significantly more often. Percutaneous drainage and antibiotics were the first steps recommended in treating mesh infection. In the presence of sepsis, most surgeons favoured synthetic mesh explantation and further repair with biological mesh.
There remains a paucity of good-quality evidence in dealing with these hernias, leading to variations in management. Patient optimization and issues related to mesh choice and infections require well designed prospective studies.
复杂腹疝患者的手术治疗具有挑战性。本研究旨在对当前实践中的专家意见进行国际概述。
设计了一份调查问卷，以调查复杂疝修补患者的术前风险管理、手术方法和补片选择，以及感染补片的治疗策略。比较了执业地点、外科医生的经验和年手术量。
408名外科医生中，234名（57.4%）在美国执业，116名（28.4%）在欧洲，58名（14.2%）在其他国家。418名外科医生中有412名（98.6%）进行开放修补，416名中有322名（77.4%）进行腹腔镜修补。大多数人推荐术前检查/生活方式改变，如戒烟（398名中的319名，80.2%）和减肥（399名中的254名，63.7%），但这些策略的效果各不相同。美国外科医生和经验较少的外科医生要求更严格。414名受访者中有295名（71.3%）在手术前至少1小时使用抗生素。在污染的原发性疝修补中，合成补片和生物补片的使用频率相同，而在复发性疝修补中，合成补片用于清洁环境，生物补片或不使用补片用于污染环境。美国外科医生和经验较少的外科医生在污染环境中更常选择生物补片。经皮引流和抗生素是治疗补片感染的首选措施。在发生脓毒症时，大多数外科医生倾向于取出合成补片，并用生物补片进行进一步修补。
在处理这些疝方面，高质量证据仍然匮乏，导致管理存在差异。患者优化以及与补片选择和感染相关的问题需要精心设计的前瞻性研究。
