Cleveland Clinic Center for Abdominal Core Health, Digestive Disease & Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH.
Department of Surgery, Massachusetts General Hospital, Boston, MA.
Ann Surg. 2023 Apr 1;277(4):e900-e906. doi: 10.1097/SLA.0000000000005443. Epub 2022 Jul 6.
We aimed to report long-term clinical and patient-reported outcomes of transversus abdominis release (TAR) with permanent synthetic mesh performed in a high-volume abdominal wall reconstruction practice.
Despite increasing utilization of TAR in abdominal wall reconstruction, long-term clinical and patient-reported outcomes remain uncertain.
Prospectively collected registry data from the Cleveland Clinic Center for Abdominal Core Health were analyzed retrospectively. Patients undergoing elective, open VHR with TAR and permanent synthetic mesh implantation between August 2014 and March 2020 with 30-day clinical and ≥1 year clinical or patient-reported outcome follow-up were included. Outcomes included composite hernia recurrence, characterized by patient-reported bulges and recurrent hernias noted on physical exam or imaging, as well as hernia-specific quality of life and pain.
A total of 1203 patients were included. Median age was 60 years [interquartile range (IQR): 52-67], median body mass index was 32 kg/m 2 (IQR: 28-36), median hernia width was 15 cm (IQR: 12-19), and 57% of hernias were recurrent. Fascial reapproximation was achieved in 92%. At a median follow-up of 2 years (IQR: 1-4), the overall composite hernia recurrence rate was 26%, with sensitivity analysis yielding best-case and worst-case estimates of 5% and 28%, respectively. Patients experienced improved hernia-specific quality of life and pain regardless of recurrence outcome; however, those who did not recur experienced more substantial improvement.
TAR with permanent synthetic mesh remains a valuable, versatile technique; however, surgeon and patient expectations should be tempered regarding long-term durability. Despite a high rate of recurrence, patients experience measurable improvements in quality of life.
我们旨在报告在高容量腹壁重建实践中进行的腹横肌释放（TAR）联合永久性合成网片的长期临床和患者报告结局。
尽管 TAR 在腹壁重建中的应用日益增多，但长期的临床和患者报告结局仍不确定。
回顾性分析克利夫兰诊所腹部核心健康中心前瞻性收集的注册数据。纳入 2014 年 8 月至 2020 年 3 月间接受择期开放 VHR 联合 TAR 和永久性合成网片植入术且术后 30 天临床随访和/或≥1 年临床或患者报告结局随访的患者。结局包括复合疝复发，表现为患者自述肿块和体检或影像学检查发现的复发性疝，以及疝特异性生活质量和疼痛。
共纳入 1203 例患者。中位年龄为 60 岁[四分位距（IQR）：52-67]，中位体重指数为 32kg/m 2（IQR：28-36），中位疝宽为 15cm（IQR：12-19），57%的疝为复发性疝。92%的患者实现了筋膜的重新接近。中位随访 2 年（IQR：1-4），总体复合疝复发率为 26%，敏感性分析得出的最佳和最差估计值分别为 5%和 28%。无论复发结局如何，患者的疝特异性生活质量和疼痛均得到改善；然而，未复发的患者改善更为显著。
TAR 联合永久性合成网片仍然是一种有价值的、多功能的技术；然而，应根据长期耐久性调整术者和患者的期望。尽管复发率较高，但患者的生活质量仍有显著改善。
