Department of General and Digestive Surgery, Poissy/Saint-Germain Medical Center, Poissy, France.
Department of General and Digestive Surgery, Poissy/Saint-Germain Medical Center, Poissy, France -
Minerva Surg. 2022 Feb;77(1):41-49. doi: 10.23736/S2724-5691.21.08779-4. Epub 2021 Apr 23.
Complex abdominal wall repair (CAWR) remains challenging, especially in contaminated fields where the use of a synthetic mesh is associated with prohibitively complication rates. Consequently, biological mesh has been proposed as an alternative. The aim of our study was to evaluate the safety and efficacy of using Permacol® in patients who had CAWR.
We retrospectively reviewed the files of patients who had CAWR using the Permacol® mesh. Analysis included patients' preoperative characteristics, procedural parameters, and early and late post-operative complications including mainly recurrence. A multivariate regression model was performed to determine factors that influence 24-months recurrence rate.
Between January 2009 and December 2018, 75 patients. The most common indication was hernia in a contaminated field (48.0%) and abdominal wall defect greater than 10 cm in diameter (36%). Overall, 44% of our patients were Centers for Disease Control (CDC) class II or III and 81.3% fall into category II or III according to the Ventral Hernia Working Group (VHWG) classification. Recurrence rate of our series was 9.3%. Complete fascial closure was achieved in 60 patients (80%). Upon univariate analysis complete fascial closure, posterior component separation, seroma drainage, BMI>30 kg/m and age >65 years, VHWD grade >2, DINDO CLAVIEN class >2 affected the recurrence rate at 2 years follow-up. When subcutaneous drains are placed prophylactically, recurrence rates drop from 38.7% (5/14) to 3.3% (2/61 patients) when drains are placed at the time of operation (P=0.02). Only fascial closure affected the 24-months recurrence rate on multivariate analysis (P<0.001).
Permacol® surgical implant use for CAWR is safe with a relatively low rate of hernia recurrence at 2 years. Prophylactic subcutaneous drain placement may reduce the risk of hernia recurrence. The presence of contaminated fields does not appear to influence hernia recurrence when Permacol® is used, in fact, the only factor that affects recurrence rate at 24-months on multivariate analysis is completeness of the fascial closure.
复杂腹壁修复（CAWR）仍然具有挑战性，尤其是在污染区域，使用合成网片与极高的并发症发生率相关。因此，生物网片已被提议作为替代方案。本研究的目的是评估 Permacol®在接受 CAWR 的患者中的安全性和有效性。
我们回顾性分析了使用 Permacol®网片进行 CAWR 的患者的档案。分析包括患者术前特征、手术参数以及早期和晚期术后并发症，主要包括复发。采用多变量回归模型确定影响 24 个月复发率的因素。
2009 年 1 月至 2018 年 12 月期间，共 75 例患者接受了 Permacol®网片的 CAWR。最常见的指征是污染区域的疝（48.0%）和直径大于 10cm 的腹壁缺损（36%）。总体而言，我们的患者中有 44%为疾病控制与预防中心（CDC）II 级或 III 级，81.3%根据腹壁疝工作组（VHWG）分类归入 II 级或 III 级。本系列的复发率为 9.3%。60 例患者（80%）实现了完全筋膜闭合。单因素分析显示，完全筋膜闭合、后分离组件、血清肿引流、BMI>30kg/m 和年龄>65 岁、VHWG 分级>2、DINDO CLAVIEN 分级>2 影响 2 年随访时的复发率。预防性放置皮下引流管时，与术中放置引流管时相比，复发率从 38.7%（5/14）降至 3.3%（61 例患者中 2 例）（P=0.02）。只有筋膜闭合在多变量分析中影响 24 个月的复发率（P<0.001）。
Permacol®手术植入物用于 CAWR 是安全的，2 年内疝复发率相对较低。预防性皮下引流管放置可能降低疝复发的风险。当使用 Permacol®时，污染区域的存在似乎不会影响疝复发，事实上，多变量分析中唯一影响 24 个月复发率的因素是筋膜闭合的完整性。
