Wouters D, Cavallaro G, Jensen Kristian K, East B, Jíšová B, Jorgensen L N, López-Cano M, Rodrigues-Gonçalves V, Stabilini C, Berrevoet F
Department for General and HPB Surgery and Liver Transplantation, University Hospital Gent, Gent, Belgium.
Digestive Disease Center, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Front Surg. 2022 Jul 13;9:847279. doi: 10.3389/fsurg.2022.847279. eCollection 2022.
Ventral hernia repair is one of the most commonly performed surgical procedures worldwide. To reduce the risk of complications, pre- and intra-operative strategies have received increasing focus in recent years. To assess possible preventive surgical strategies, this European Hernia Society endorsed project was launched. The aim of this review was to evaluate the current literature focusing on pre- and intra-operative strategies for surgical site occurrences (SSO) and specifically surgical site infection (SSI) in ventral hernia repair.
A systematic review was conducted and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases used were Pubmed and Web of Science. Original retrospective or prospective human adult studies describing at least one intra-operative intervention to reduce SSO after ventral hernia repair were considered eligible.
From a total of 4775 results, a total of 18 papers were considered suitable after full text reading. Prehospital chlorhexidine gluconate (CHG) scrub appears to increase the risk of SSO in patients undergoing ventral hernia repair, while there is no association between any type of surgical hat worn and the incidence of postoperative wound events. Intraoperative measures as prophylactic negative pressure therapy, surgical drain placement and the use of quilt sutures seem beneficial for decreasing the incidence of SSO and/or SSI. No positive effect has been shown for antibiotic soaking of a synthetic mesh, nor for the use of fibrin sealants.
This review identified a limited amount of literature describing specific preventive measures and techniques during ventral hernia repair. An advantage of prophylactic negative pressure therapy in prevention of SSI was observed, but different tools to decrease SSIs and SSOs continuously further need our full attention to improve patient outcomes and to lower overall costs.
腹疝修补术是全球最常开展的外科手术之一。为降低并发症风险，术前和术中策略近年来受到越来越多的关注。为评估可能的预防性手术策略，启动了这项欧洲疝学会认可的项目。本综述的目的是评估当前聚焦于腹疝修补术中手术部位事件（SSO），特别是手术部位感染（SSI）的术前和术中策略的文献。
按照系统评价和Meta分析的首选报告项目声明进行系统评价并报告。使用的数据库是PubMed和科学网。描述至少一种腹疝修补术后减少SSO的术中干预措施的原始回顾性或前瞻性成人研究被认为符合条件。
在总共4775条结果中，全文阅读后共有18篇论文被认为合适。术前葡萄糖酸氯己定（CHG）擦洗似乎会增加腹疝修补术患者发生SSO的风险，而佩戴任何类型的手术帽与术后伤口事件的发生率之间均无关联。术中措施如预防性负压治疗、放置手术引流管和使用褥式缝线似乎有利于降低SSO和/或SSI的发生率。合成补片抗生素浸泡以及使用纤维蛋白密封剂均未显示出积极效果。
本综述发现描述腹疝修补术中特定预防措施和技术的文献数量有限。观察到预防性负压治疗在预防SSI方面具有优势，但仍需要我们持续充分关注不同的降低SSI和SSO的工具，以改善患者预后并降低总体成本。
