Department of General, Visceral and Transplantation Surgery, University Hospital RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Germany.
BMC Surg. 2021 Sep 27;21(1):353. doi: 10.1186/s12893-021-01350-9.
Patients with inflammatory bowel disease (IBD) have a high-life time risk undergoing abdominal surgery and are prone to develop incisional hernias (IH) in the postoperative course. Therefore, we investigated the role of IBD as perioperative risk factor in open ventral hernia repair (OVHR) as well as the impact of IBD on hernia recurrence during postoperative follow-up.
The postoperative course of 223 patients (Non-IBD (n = 199) and IBD (n = 34)) who underwent OVHR were compared by means of extensive group comparisons and binary logistic regressions. Hernia recurrence was investigated in the IBD group according to the Kaplan-Meier method and risk factors for recurrence determined by Cox regressions.
General complications (≥ Clavien-Dindo I) occurred in 30.9% (72/233) and major complications (≥ Clavien-Dindo IIIb) in 7.7% (18/233) of the overall cohort with IBD being the single independent risk-factor for major complications (OR = 4.2, p = 0.007). Further, IBD patients displayed a recurrence rate of 26.5% (9/34) after a median follow-up of 36 months. Multivariable analysis revealed higher rates of recurrence in patients with ulcerative colitis (UC, 8/15, HR = 11.7) compared to patients with Crohn's disease (CD, 1/19, HR = 1.0, p = 0.021).
IBD is a significant risk factor for major postoperative morbidity after OVHR. In addition, individuals with IBD show high rates of hernia recurrence over time with UC patients being more prone to recurrence than patients with CD.
炎症性肠病（IBD）患者一生中有很高的腹部手术风险，并且在术后易发生切口疝（IH）。因此，我们研究了 IBD 作为开放式腹侧疝修补术（OVHR）围手术期危险因素的作用，以及 IBD 对术后随访中疝复发的影响。
通过广泛的组间比较和二项逻辑回归比较了 223 例接受 OVHR 的患者（非 IBD（n=199）和 IBD（n=34））的术后过程。根据 Kaplan-Meier 法对 IBD 组的疝复发进行调查，并通过 Cox 回归确定复发的危险因素。
总体并发症（≥Clavien-Dindo I）发生率为 30.9%（72/233），主要并发症（≥Clavien-Dindo IIIb）发生率为 7.7%（18/233），IBD 是主要并发症的唯一独立危险因素（OR=4.2，p=0.007）。此外，IBD 患者在中位随访 36 个月后复发率为 26.5%（9/34）。多变量分析显示，溃疡性结肠炎（UC）患者的复发率更高（8/15，HR=11.7），而克罗恩病（CD）患者的复发率更低（1/19，HR=1.0，p=0.021）。
IBD 是 OVHR 术后严重发病率的重要危险因素。此外，IBD 患者随时间疝复发率较高，UC 患者比 CD 患者更容易复发。
