感染后疝修补网片取出的事件、治疗和结局。
Events, care, and outcomes after hernia mesh explantation for infection.
机构信息
VA Boston Dept. of Surgery, 1400 VFW Parkway, Boston, MA, 02132, USA.
VA Boston CHOIR, 150 S. Huntington Ave, Boston, MA, 02130, USA.
出版信息
Am J Surg. 2022 Jul;224(1 Pt A):174-176. doi: 10.1016/j.amjsurg.2021.11.036. Epub 2021 Dec 2.
BACKGROUND
Mesh explantation for infection after hernia surgery sets a cascade of events that has not been previously described. The purpose of this study is to review the care of these patients and outcomes.
METHODS
We obtained data on all Veterans Health Administration enrollees undergoing hernia repair during 2008-2015. All mesh explantation cases were identified and manually reviewed through December 2020 to identify surgical site occurrences, re-repairs, and subsequent explantations.
RESULTS
We identified 332 index explantations due to infection. A first subsequent repair was performed in 82.5% (274/332); a second repair in 18.2% (50/274); a third repair in 16.0% (8/50); and a fourth repair in 25% (2/8). Overall recurrence rate over a 12 year-period was 160/332 (48.1%).
CONCLUSIONS
Mesh explantation due to infection sets a cascade of complications and hernia recurrences necessitating re-operation. Complications resulting from mesh explantation suggest that resolution of the initial abdominal wall infection is crucial to prevent future mesh infections.
背景
疝修补术后发生感染需进行补片取出，由此引发了一系列此前尚未描述过的事件。本研究旨在回顾此类患者的治疗方法和结果。
方法
我们获取了 2008 年至 2015 年间所有在退伍军人事务部医疗体系中接受疝修补术的患者的数据。所有补片取出病例均经手动审核（截至 2020 年 12 月）以确定手术部位发生的情况、再次修补和随后的补片取出。
结果
我们共发现 332 例因感染而行的初次补片取出。82.5%（274/332）的患者接受了初次修补，18.2%（50/274）的患者接受了第二次修补，16.0%（50/274）的患者接受了第三次修补，25.0%（2/8）的患者接受了第四次修补。12 年内总体复发率为 160/332（48.1%）。
结论
感染导致的补片取出会引发一系列并发症和疝复发，需要再次手术。补片取出引起的并发症表明，解决初始腹壁感染对于预防未来的补片感染至关重要。
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