Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium.
Department of Abdominal Surgery, Viecuri Medical Centre, Venlo, The Netherlands.
Surg Technol Int. 2021 May 20;38:186-192. doi: 10.52198/21.STI.38.HR1418.
Abdominal wall hernia repair in contaminated cases remains a therapeutic challenge due to the high risk of post-operative surgical site occurrences (SSO). Slowly resorbable synthetic (biosynthetic) meshes have recently been introduced and may offer unique advantages when challenged with bacterial colonization during abdominal wall reconstruction.
A multicenter single-arm retrospective observational cohort study examined all consecutive patients in whom a poly-4-hydroxybutyrate mesh (Phasix™ or Phasix™ ST; Becton Dickinson, Franklin Lakes, NJ, USA) was used for the repair of an inguinal or ventral/incisional hernia, or to replace an infected synthetic mesh. Patient records were analyzed according to the level of contamination, using the classification score of the Centers for Disease Control and Prevention (CDC). The primary objective was to evaluate short-term postoperative morbidity by assessing SSOs and the need for reoperation or even mesh excision.
A total of 47 patients were included. The median age was 68 years (30-87), the male/female ratio was 26/21, and the median BMI was 26.5 kg/m2 (16.4-46.8). There were 17 clean cases, 17 clean-contaminated, 6 contaminated and 7 dirty. Median follow-up time was 48 days. An SSO was seen in 4 clean (23.5%), 7 clean-contaminated (41.2%), 2 contaminated (33.3%) and 5 dirty cases (71.4%). A surgical site occurrence requiring procedural intervention (SSOPI) was seen in 2 clean (11.8%), 3 clean-contaminated (17.6%), 1 contaminated (16.7%) and 2 dirty cases (28.6%). Hernia recurrence was seen in 1 clean (5.9%), 2 clean-contaminated (11.8%) and 3 dirty cases (42.9%). Mesh excision had to be performed in only one case in the contaminated group.
The Phasix™ mesh shows promising short-term results when used in contaminated hernia-related surgery. Even in contaminated or dirty conditions, with or without infection of the mesh, resection of the mesh only had to be performed once and patients could be managed either conservatively or by relatively minor reoperations. However, further research is needed to fully evaluate the safety and efficacy of these meshes.
由于腹部壁疝修补术后发生手术部位感染（SSO）的风险较高，污染情况下的腹壁疝修复仍然是一个治疗挑战。最近引入了可缓慢吸收的合成（生物合成）网片，当在腹壁重建过程中遇到细菌定植时，它们可能具有独特的优势。
一项多中心单臂回顾性观察队列研究检查了所有连续接受聚 4-羟基丁酸酯网片（Phasix™ 或 Phasix™ ST；Becton Dickinson，Franklin Lakes，NJ，美国）用于修复腹股沟或腹侧/切口疝，或更换感染性合成网片的患者。根据疾病控制与预防中心（CDC）的分类评分，根据污染程度分析患者记录。主要目的是通过评估 SSO 和再次手术或甚至网片切除的需要来评估短期术后发病率。
共纳入 47 例患者。中位年龄为 68 岁（30-87），男女比例为 26/21，中位 BMI 为 26.5kg/m2（16.4-46.8）。有 17 例清洁病例，17 例清洁污染，6 例污染和 7 例污染。中位随访时间为 48 天。4 例清洁（23.5%）、7 例清洁污染（41.2%）、2 例污染（33.3%）和 5 例污染（71.4%）出现 SSO。2 例清洁（11.8%）、3 例清洁污染（17.6%）、1 例污染（16.7%）和 2 例污染（28.6%）需要手术干预的手术部位感染（SSOPI）。1 例清洁（5.9%）、2 例清洁污染（11.8%）和 3 例污染（42.9%）出现疝复发。仅在污染组中进行了一次网片切除。
Phasix™ 网片在污染相关疝手术中具有良好的短期效果。即使在污染或污染环境中，无论网片是否感染，仅需切除网片一次，并且可以通过保守治疗或相对较小的再次手术来管理患者。然而，还需要进一步的研究来全面评估这些网片的安全性和有效性。
