Van Orden Kathryn, Santos Jeffrey, Stanfield Brent, Frost Landon S, Ruditsky Alexander, Foster Andrea, Brahmbhatt Tejal S, Burke Peter A, Fernandez-Moure Joseph, Haines Krista, Agarwal Suresh, Kasotakis George
Division of Trauma, Acute Care Surgery and Surgical Critical Care, Boston Medical Center, Boston University School of Medicine, Boston, MA, 02118, USA.
Department of Surgery, Division of Trauma, Acute Care Surgery and Surgical Critical Care, Duke University Medical Center, Duke University School of Medicine, 40 Duke Medicine Circle, Duke South, #1557A, Durham, NC, 27710, USA.
Eur J Trauma Emerg Surg. 2022 Jun;48(3):1993-2001. doi: 10.1007/s00068-021-01641-z. Epub 2021 Mar 13.
The management of complicated ventral hernias (CVH), namely ventral hernias in actively or recently infected/contaminated operative fields, and open abdomens in which the native fascia cannot be primarily reapproximated, pose a surgical challenge. Fetal Bovine and Porcine Acellular Dermal Matrix (BADM and PADM) biologic meshes are being increasingly used in these scenarios. A comparison, however, of clinically relevant outcomes between the two is lacking. With this investigation, we aim to review and compare clinically relevant outcomes in patients that underwent abdominal wall herniorrhaphy with either BADM or PADM at a tertiary urban academic institution over a 5-year period.
Patients who had a BADM or PADM implanted during CVH over a 5-year period at a tertiary urban academic hospital were identified. Baseline clinical and hernia characteristics, as well as postoperative outcomes were compared after a retrospective chart review. Phone interviews were also conducted to assess for recurrence, followed by in-person visits as indicated. Cox Proportional Hazard regression was fitted to identify risk factors for recurrence.
Of the 140 patients who underwent biologic mesh implantation for CVH, 109 were for ventral hernia repair and 31 for open abdomen bridging. Mean age was 52.7 ± 14.2 and males constituted 57.9% of our sample, while 25.1% had undergone > 5 prior abdominal operations. Thirty percent were active smokers, and another 30% required emergency surgery. Only immunosuppression was a risk factor for recurrence [HR 13.3 (1.04-169.2), p = 0.047] on Cox Proportional Hazard regression, while mesh selection had no effect.
Both BADM and PADM meshes perform well in CVH, with satisfactory recurrence rates, only slightly higher compared to traditional synthetic mesh repairs.
复杂腹疝（CVH）的处理，即活跃期或近期感染/污染手术区域的腹疝，以及无法一期重新对合天然筋膜的开放性腹部，是一项外科挑战。胎牛和猪脱细胞真皮基质（BADM和PADM）生物补片在这些情况下的使用越来越多。然而，两者之间缺乏临床相关结局的比较。通过这项研究，我们旨在回顾和比较在一家城市三级学术机构接受腹壁疝修补术并使用BADM或PADM的患者在5年期间的临床相关结局。
确定在一家城市三级学术医院5年期间CVH手术中植入BADM或PADM的患者。回顾性查阅病历后比较基线临床和疝的特征以及术后结局。还进行了电话访谈以评估复发情况，必要时进行当面随访。采用Cox比例风险回归来确定复发的危险因素。
在140例接受生物补片植入治疗CVH的患者中，109例进行腹疝修补，31例进行开放性腹部桥接。平均年龄为52.7±14.2岁，男性占样本的57.9%，2
