Department of Surgery, NorthShore University Health System, Evanston, IL; Department of Surgery, University of Chicago Medical Center, Chicago, IL.
Department of Surgery, NorthShore University Health System, Evanston, IL.
J Am Coll Surg. 2021 Jul;233(1):51-62. doi: 10.1016/j.jamcollsurg.2021.03.006. Epub 2021 Mar 18.
The use of mesh in hernia repair has faced intense scrutiny, leading patients to become fearful of its use, despite its benefits in reducing hernia recurrence. We report a single institutional experience in performing hernia repair with mesh in terms of hernia-specific outcomes, mesh-related complications, and patient-reported quality of life.
Patients who underwent abdominal wall hernia repair with mesh at a single institution were identified from a prospectively maintained quality database. Demographic, perioperative, and postoperative outcomes data were analyzed. Surgical Outcomes Measurements System (SOMS) and Carolinas Comfort Scale (CCS) surveys were administered pre- and postoperatively at 3 weeks, 6 months, 1, 2, and 5 years.
Between 2010 and 2020, a total of 6,387 patients underwent abdominal hernia repair with mesh. Inguinal hernia repairs made up the majority (65%) of the operations. Rates of mesh infection varied by hernia type, with lower rates after umbilical (0.0%) and inguinal (0.4%) repair, and highest after incisional repair (1.3%). Similarly, mesh explantation rates were low after umbilical and inguinal repair (0.0% and 0.4%, respectively) and highest after incisional repair (3.0%). Scores on all SOMS domains were significantly improved from baseline (all p < 0.05). On CCS, 2.9%, 3.3%, and 4.4% of patients reported severe or disabling symptoms postoperatively at 1, 2, and 5 years, respectively.
Rates of mesh-related complications vary by hernia type. A majority of patients report excellent long-term quality of life, although a relatively large percentage of patients experience severe or disabling symptoms at long-term follow-up.
尽管网片在降低疝复发方面具有优势，但在疝修补术中的应用仍面临严格审查，导致患者对其应用产生恐惧。我们报告了一家机构在疝修补术中使用网片的单一经验，包括疝特异性结局、与网片相关的并发症和患者报告的生活质量。
从一个前瞻性维护的质量数据库中确定了在一家机构接受腹壁疝修补术和网片的患者。分析了人口统计学、围手术期和术后结果数据。在术前、术后 3 周、6 个月、1 年、2 年和 5 年时，使用外科手术结果测量系统（SOMS）和卡罗来纳舒适度量表（CCS）进行了调查。
2010 年至 2020 年期间，共有 6387 名患者接受了腹部疝修补术和网片。腹股沟疝修复术占手术的大多数（65%）。疝类型不同，网片感染率也不同，脐疝（0.0%）和腹股沟疝（0.4%）修复后的感染率较低，而切口疝修复后的感染率最高（1.3%）。同样，脐疝和腹股沟疝修复后网片取出率较低（分别为 0.0%和 0.4%），而切口疝修复后网片取出率最高（3.0%）。所有 SOMS 域的评分均较基线显著改善（均 p<0.05）。在 CCS 上，分别有 2.9%、3.3%和 4.4%的患者在术后 1、2 和 5 年报告严重或致残症状。
网片相关并发症的发生率因疝类型而异。大多数患者报告长期生活质量良好，尽管仍有相当一部分患者在长期随访中报告严重或致残症状。
