Memba Robert, Morató Olga, Estalella Laia, Pavel Mihai C, Llàcer-Millán Erik, Achalandabaso Mar, Julià Elisabet, Padilla Erlinda, Olona Carles, O'Connor Donal, Jorba Rosa
Hepato-Pancreato-Biliary Unit, General Surgery Department, University Hospital of Tarragona Joan XXIII, Tarragona, Spain.
School of Medicine, Rovira i Virgili University, Reus, Spain.
Dig Surg. 2022;39(1):6-16. doi: 10.1159/000521169. Epub 2021 Dec 7.
Most hepato-pancreato-biliary (HPB) procedures are still performed through open approach. Incisional hernia (IH) is one of the most common complications after open surgery. To date, published data on IH after HPB surgery are scarce; therefore, the aim of this study was to assess the current evidence regarding incidence, risk factors, and prevention.
Medline/PubMed (1946-2020), EMBASE (1947-2020), and the Cochrane library (1995-2020) were searched for studies on IH in open HPB surgery. Animal studies, editorials, letters, reviews, comments, short case series and liver transplant, laparoscopic, or robotic procedures were excluded. The protocol was registered with PROSPERO (CRD42020163296).
A total of 5,079 articles were retrieved. Eight studies were finally included for the analysis. The incidence of IH after HPB surgery ranges from 7.7% to 38.8%. The identified risk factors were body mass index, surgical site infection, ascites, Mercedes or reversed T incisions, and previous IH. Prophylactic mesh might be safe and effective.
IH after open HPB surgery is still an important matter. Some of the risk factors are specific for the HPB operations and the incision type should be carefully considered. Randomized controlled trials are required to confirm the role of prophylactic mesh after HPB operations.
大多数肝胰胆（HPB）手术仍通过开放手术方式进行。切口疝（IH）是开放手术后最常见的并发症之一。迄今为止，关于HPB手术后切口疝的已发表数据很少；因此，本研究的目的是评估有关发病率、危险因素和预防措施的现有证据。
检索Medline/PubMed（1946 - 2020年）、EMBASE（1947 - 2020年）和Cochrane图书馆（1995 - 2020年）中关于开放HPB手术中切口疝的研究。排除动物研究、社论、信件、综述、评论、短篇病例系列以及肝移植、腹腔镜或机器人手术相关研究。该方案已在PROSPERO（CRD42020163296）注册。
共检索到5079篇文章。最终纳入8项研究进行分析。HPB手术后切口疝的发病率在7.7%至38.8%之间。已确定的危险因素包括体重指数、手术部位感染、腹水、梅赛德斯或倒T形切口以及既往切口疝。预防性使用补片可能是安全有效的。
开放HPB手术后的切口疝仍然是一个重要问题。一些危险因素是HPB手术特有的，应仔细考虑切口类型。需要进行随机对照试验来证实HPB手术后预防性使用补片的作用。
