The Permanente Medical Group, Department of General Surgery, Kaiser Permanente Santa Rosa Medical Center, Santa Rosa, CA, USA.
Department of General Surgery, Kaiser Permanente Santa Rosa Medical Center, Medical Office Building 2, Suite 260, 401 Bicentennial Way, Santa Rosa, CA, 95403, USA.
Surg Endosc. 2022 Aug;36(8):5766-5771. doi: 10.1007/s00464-022-09058-4. Epub 2022 Feb 7.
The proper approach to repair of complex abdominal wall hernia in contaminated and dirty surgical fields is unknown. Identification of a surgical approach limiting the number of operative procedures, post-operative complications, and financial burden is needed. We hypothesized that single-stage abdominal wall reconstruction using poly-4-hydroxybutyrate resorbable mesh would result in low incidence of post-operative surgical site occurrence and a low incidence of hernia recurrence in Centers for Disease Control class III and IV wounds.
We conducted a single institution, retrospective cohort study of consecutive patients, age greater than 18 years old, that underwent abdominal wall reconstruction complicated by presence of Centers for Disease Control class III and IV wounds between January 2014 and March 2019. Primary outcomes assessed were surgical site occurrence, hernia recurrence, and mesh-related adverse events.
Thirty-four patients that underwent single-stage abdominal wall reconstruction utilizing poly-4-hydroxybutyrate mesh with contaminated (n = 12) and dirty/infected wounds (n = 22) were identified. Patients mean age was 64 years, and body mass index was 31 kg/m. Mean follow-up was 37 months, range of 21-60. Concurrent procedures included fistula takedown (n = 9), infected mesh removal (n = 6), and parastomal hernia repair (n = 6). Mean defect size was 150.7 cm. Surgical site occurrence rate was 12%, with 1 superficial and 2 deep surgical site infections. Midline hernia recurrence rate was 0, there were two parastomal hernia recurrences, for an overall hernia recurrence rate of 6%. No mesh-related adverse events occurred.
This study suggests that over a 3-year follow-up period single-stage complex abdominal wall reconstruction with poly-4-hydroxybutyrate is safe and durable. Single-stage complex abdominal wall reconstruction with poly-4-hydroxybutyrate mesh in the setting of Centers for Disease Control class III and IV wounds is a realistic option with acceptable outcomes.
在污染和脏污手术区域中，修复复杂腹壁疝的适当方法尚不清楚。需要确定一种手术方法，该方法可减少手术程序、术后并发症和经济负担。我们假设，使用聚 4-羟基丁酸酯可吸收网片进行一期腹壁重建，可使疾病预防控制中心（CDC）III 类和 IV 类伤口的术后手术部位感染发生率和疝复发率降低。
我们对 2014 年 1 月至 2019 年 3 月连续接受了伴有疾病预防控制中心 III 类和 IV 类伤口的腹壁重建的患者进行了单机构回顾性队列研究。主要结局评估包括手术部位感染、疝复发和网片相关不良事件。
确定了 34 例接受了聚 4-羟基丁酸酯网片一期腹壁重建的患者，其中污染（n=12）和脏污/感染伤口（n=22）。患者平均年龄为 64 岁，体重指数为 31kg/m。平均随访时间为 37 个月，范围为 21-60 个月。同时进行的手术包括瘘管切除（n=9）、感染性网片切除（n=6）和造口旁疝修补（n=6）。平均缺损大小为 150.7cm。手术部位感染发生率为 12%，其中 1 例为浅表感染，2 例为深部感染。中线疝复发率为 0，有 2 例造口旁疝复发，总疝复发率为 6%。无网片相关不良事件发生。
本研究表明，在 3 年的随访期间，聚 4-羟基丁酸酯的一期复杂腹壁重建是安全且持久的。在疾病预防控制中心 III 类和 IV 类伤口的情况下，使用聚 4-羟基丁酸酯网片进行一期复杂腹壁重建是一种可行的选择，其结果可以接受。
