Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA; Department of Surgery, Thomas Jefferson University, Philadelphia, PA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
J Surg Res. 2021 Aug;264:199-207. doi: 10.1016/j.jss.2021.02.012. Epub 2021 Apr 7.
While mesh re-enforcement and advanced surgical techniques are cornerstones of complex ventral hernia repair (CVHR), the risk of complications and recurrence is common. We aim to evaluate the efficacy, safety, and patient reported outcomes (PROs) of patients undergoing CVHR with onlay Poly-4-hydroxybutyrate (P4HB).
Adult (>18 y old) patients undergoing VHR with P4HB (Phasix) in the onlay plane by a single surgeon from 01/2015 to 05/2020 were reviewed. VHR was considered complex if patients had significant co-morbidities, large abdominal wall defects, a history of extensive abdominal surgery, and/or concurrent intra-abdominal pathology. A composite of postoperative outcomes including surgical site occurrences (SSO), surgical site infection (SSI), and surgical site occurrences requiring procedural intervention (SSOpi), as well as PROs as defined by the Abdominal Hernia-Q (AHQ), were analyzed.
A total of 51 patients were included with average age and body mass index of 56.4 and 29.9 kg/m. Median follow up was 20 mo with a hernia recurrence rate of 5.9% (n = 3). 21 patients had an SSO (41.2%), 8 had an SSI (15.7%), and 6 had an SSOpi (11.8%). There was an association with Ventral Hernia Working Group ≥ 2 and development of SSO. There was a significant improvement in overall PROs (P < 0.0001) with no difference in those patients with and without complications (P > 0.05).
For hernia patients with large defects and complex intra-abdominal pathology, a safe and effective repair is difficult. The use of onlay P4HB was associated with acceptable postoperative outcomes and recurrence rate.
虽然网片加强和先进的手术技术是复杂腹疝修复（CVHR）的基石，但并发症和复发的风险是常见的。我们旨在评估在单个外科医生的指导下，对接受腹侧疝修补术的患者使用覆盖 Poly-4-hydroxybutyrate（P4HB）的疗效、安全性和患者报告的结果（PROs）。
对 2015 年 1 月至 2020 年 5 月期间接受 P4HB（Phasix）覆盖平面 VHR 的成年（>18 岁）患者进行回顾性分析。如果患者有明显的合并症、大的腹壁缺损、广泛的腹部手术史和/或同时存在腹腔内病变，则认为 VHR 是复杂的。将包括术后结果（SSO）、手术部位感染（SSI）和需要手术干预的手术部位并发症（SSOpi）在内的综合结果以及腹疝-Q（AHQ）定义的 PROs 进行分析。
共纳入 51 例患者，平均年龄和体重指数分别为 56.4 岁和 29.9kg/m。中位随访时间为 20 个月，疝复发率为 5.9%（n=3）。21 例患者有 SSO（41.2%），8 例有 SSI（15.7%），6 例有 SSOpi（11.8%）。VHWG≥2 与 SSO 的发生有关。总体 PROs 显著改善（P<0.0001），但并发症患者和无并发症患者之间无差异（P>0.05）。
对于有大缺陷和复杂腹腔内病变的疝患者，安全有效的修复是困难的。使用覆盖 P4HB 与可接受的术后结果和复发率相关。
