Department of Surgery, Children's Mercy Kansas City, 2401 Gillham Road, Kansas City MO 64108, United States.
Center for Surgical Outcomes Research, Abigail Wexner Research Institute and Department of Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States.
J Pediatr Surg. 2022 Dec;57(12):786-791. doi: 10.1016/j.jpedsurg.2022.03.019. Epub 2022 Mar 26.
We evaluate the incidence, outcomes, and management of peri‑umbilical hernias after sutured or sutureless gastroschisis closure.
A retrospective, longitudinal follow-up of neonates with gastroschisis who underwent closure at 11 children's hospitals from 2013 to 2016 was performed. Patient encounters were reviewed through 2019 to identify the presence of a peri‑umbilical hernia, time to spontaneous closure or repair, and associated complications.
Of 397 patients, 375 had follow-up data. Sutured closure was performed in 305 (81.3%). A total of 310 (82.7%) infants had uncomplicated gastroschisis. Peri-umbilical hernia incidence after gastroschisis closure was 22.7% overall within a median follow-up of 2.5 years [IQR 1.3,3.9], and higher in those with uncomplicated gastroschisis who underwent primary vs. silo assisted closure (53.0% vs. 17.2%, p< 0.001). At follow-up, 50.0% of sutureless closures had a persistent hernia, while 16.4% of sutured closures had a postoperative hernia of the fascial defect (50.0% vs. 16.4%, p< 0.001). Spontaneous closure was observed in 38.8% of patients within a median of 17 months [9,26] and most frequently observed in those who underwent a sutureless primary closure (52.2%). Twenty-seven patients (31.8%) underwent operative repair within a median of 13 months [7,23.5]. Rate and interval of spontaneous closure or repair were similar between the sutured and sutureless closure groups, with no difference between those who underwent primary vs. silo assisted closure.
Peri-umbilical hernias after sutured or sutureless gastroschisis closure may be safely observed similar to congenital umbilical hernias as spontaneous closure occurs, with minimal complications and no additional risk with either closure approach.
Level II.
我们评估了缝合或无缝合关腹术治疗后脐旁疝的发生率、结局和处理方法。
对 2013 年至 2016 年 11 家儿童医院接受关腹术的先天性腹裂患儿进行了回顾性、纵向随访。通过 2019 年的患者就诊记录，明确是否存在脐旁疝、自发性闭合或修复的时间以及相关并发症。
397 例患儿中，375 例有随访数据。其中 305 例行缝合关腹术（81.3%）。310 例（82.7%）患儿的先天性腹裂未合并其他并发症。中位随访 2.5 年（IQR 1.33.9）期间，总体脐旁疝的发生率为 22.7%，与单纯性先天性腹裂患儿相比，行原发性 vs. 经皮穿刺造口术辅助关腹术的患儿脐旁疝发生率更高（53.0% vs. 17.2%，p<0.001）。随访时，无张力关腹术 50.0%患儿仍存在疝，而缝合关腹术术后疝的发生率为 16.4%（筋膜缺损）（50.0% vs. 16.4%，p<0.001）。中位随访 17 个月[926]时，38.8%的患儿自发性闭合，其中行无张力原发性关腹术的患儿最常出现自发性闭合（52.2%）。27 例患儿（31.8%）行手术修复，中位时间为 13 个月[7~23.5]。缝合组和无张力组的自发性闭合或修复的发生率和间隔时间相似，行原发性 vs. 经皮穿刺造口术辅助关腹术的患儿也无差异。
缝合或无张力关腹术后的脐旁疝可类似于先天性脐疝一样安全观察，因为自发性闭合的发生，并发症较少，两种关腹术方式均无额外风险。
Ⅱ级。
