Departments of Surgery, School of Medical Sciences, Örebro University Hospital, Örebro University, Stockholm, Sweden.
Örebro University Hospital, Faculty of Medicine and Health, Örebro University, Stockholm, Sweden.
Hernia. 2022 Dec;26(6):1551-1559. doi: 10.1007/s10029-022-02645-3. Epub 2022 Jul 8.
The aim of this study was to analyse the risk for reoperation following primary ventral hernia repair.
The study was based on umbilical hernia and epigastric hernia repairs registered in the population-based Swedish National Patient Register (NPR) 2010-2019. Reoperation was defined as repeat repair after primary repair.
Altogether 29,360 umbilical hernia repairs and 6514 epigastric hernia repairs were identified. There were 624 reoperations registered following primary umbilical repair and 137 following primary epigastric repairs. In multivariable Cox proportional hazard analysis, the hazard ratio (HR) for reoperation was 0.292 (95% confidence interval (CI) 0.109-0.782) after open onlay mesh repair, 0.484 (CI 0.366-0.641) after open interstitial mesh repair, 0.382 (CI 0.238-0.613) after open sublay mesh repair, 0.453 (CI 0.169-1.212) after open intraperitoneal onlay mesh repair, 1.004 (CI 0.688-1.464) after laparoscopic repair, and 0.940 (CI 0.502-1.759) after other techniques, when compared to open suture repair as reference method. Following umbilical hernia repair, the risk for reoperation was also significantly higher for patients aged < 50 years (HR 1.669, CI 1.389-2.005), for women (HR 1.401, CI 1.186-1.655), and for patients with liver cirrhosis (HR 2.544, CI 1.049-6.170). For patients undergoing epigastric hernia repair, the only significant risk factor for reoperation was age < 50 years (HR 2.046, CI 1.337-3.130).
All types of open mesh repair were associated with lower reoperation rates than open suture repair and laparoscopic repair. Female sex, young age and liver cirrhosis were risk factors for reoperation due to hernia recurrence, regardless of method.
本研究旨在分析初次腹侧疝修补术后再次手术的风险。
该研究基于瑞典全国患者登记系统（NPR）2010-2019 年登记的脐疝和上腹疝修复数据。再次手术定义为初次修复后再次修复。
共确定了 29360 例脐疝修复和 6514 例上腹疝修复。初次脐疝修复后有 624 例再次手术，初次上腹疝修复后有 137 例再次手术。多变量 Cox 比例风险分析显示，开放式无张力修补术后再次手术的风险比（HR）为 0.292（95%置信区间（CI）0.109-0.782），开放式间隔网片修补术为 0.484（CI 0.366-0.641），开放式下网片修补术为 0.382（CI 0.238-0.613），开放式腹膜前网片修补术为 0.453（CI 0.169-1.212），腹腔镜修补术为 1.004（CI 0.688-1.464），其他技术为 0.940（CI 0.502-1.759），与开放式缝合修补术相比。与脐疝修复相比，年龄<50 岁（HR 1.669，CI 1.389-2.005）、女性（HR 1.401，CI 1.186-1.655）和肝硬化患者（HR 2.544，CI 1.049-6.170）再次手术的风险也显著更高。对于上腹疝修复患者，再次手术的唯一显著危险因素是年龄<50 岁（HR 2.046，CI 1.337-3.130）。
与开放式缝合修补术和腹腔镜修补术相比，所有类型的开放式网片修补术的再次手术率均较低。女性、年轻和肝硬化是疝复发的再手术危险因素，与方法无关。
