Faculty of Health Sciences, Department of General Surgery, School of Medical Sciences, Esenyurt University, Istanbul, Turkey.
Department of General Surgery, Istanbul Training and Research Hospital, Istanbul, Turkey.
Langenbecks Arch Surg. 2021 Aug;406(5):1651-1657. doi: 10.1007/s00423-021-02145-5. Epub 2021 Mar 17.
The use of synthetic materials in emergency surgery for abdominal wall hernia in a potentially infected operating field has long been debated. In the present study, we evaluated the outcome of mesh prostheses in the management of incarcerated and strangulated abdominal wall hernias with or without organ resection.
Between March 2012 and January 2020, medical records of 301 patients who underwent emergency surgery for incarcerated and strangulated abdominal wall hernias were retrospectively evaluated. The interventions were exclusively realized by two surgical teams, one of which used polypropylene mesh prostheses (group I), whereas the second team performed primary hernia repair (group II). The outcome of patients was observed for a mean follow-up period of 18.2 months. Categorical data were analyzed with the χ2 test or likelihood ratio. Logistic regression was used for adjustments in multivariate analysis. Statistical analyses were realized with SPSS, version 18. P values < 0.05 were considered statistically significant. For multiple comparisons between types of hernia, the significance level was set to P < 0.0083 according to Bonferroni adjustment.
Of the 301 patients, 190 were men (63.1%), and 111 were women (36.9%). The mean age was 59,98 years (range 17-92). Overall, 226 (75.1%) patients were treated with synthetic mesh replacement. One hundred two organ resections (34%) were performed involving the omentum, small intestine, colon, and appendix. No significant difference was identified in terms of postoperative complications, between the two groups both in patients who underwent organ resection and in patients who did not.
Synthetic materials may safely be used in the emergency management of incarcerated and strangulated groin and abdominal wall hernias in patients with or without organ resection, although they cannot formally be recommended due to the limited number of cases of the present study.
在潜在感染手术部位的腹壁疝的急诊手术中使用合成材料一直存在争议。在本研究中，我们评估了在有或没有器官切除的情况下，使用网片修补术治疗嵌顿性和绞窄性腹壁疝的结果。
回顾性分析 2012 年 3 月至 2020 年 1 月期间 301 例接受嵌顿性和绞窄性腹壁疝急诊手术的患者的病历。干预措施完全由两个手术团队完成，其中一个团队使用聚丙烯网片（I 组），而另一个团队进行了原发性疝修补术（II 组）。对患者进行了平均 18.2 个月的随访。采用卡方检验或似然比进行分类数据的分析。采用 Logistic 回归进行多变量分析中的调整。统计分析采用 SPSS 18 版。P 值<0.05 为统计学显著。对于不同类型疝之间的多重比较，根据 Bonferroni 调整，将显著性水平设定为 P<0.0083。
301 例患者中，男性 190 例（63.1%），女性 111 例（36.9%）。平均年龄为 59.98 岁（范围 17-92 岁）。总体上，226 例（75.1%）患者接受了合成网片置换。102 例（34%）患者行器官切除术，涉及网膜、小肠、结肠和阑尾。在进行器官切除术的患者和未进行器官切除术的患者中，两组患者的术后并发症无显著差异。
在有或没有器官切除的情况下，合成材料可安全用于嵌顿性和绞窄性腹股沟和腹壁疝的急诊治疗，尽管由于本研究病例数有限，不能正式推荐使用。
