Baig S J, Afaque M Y, Priya P, Sheth H, Goel R, Mahawar K K, Agarwalla R
Belle Vue Clinic, Kolkata, India.
J N Medical College, Aligarh Muslim University, Aligarh, India.
Hernia. 2022 Dec;26(6):1573-1581. doi: 10.1007/s10029-022-02666-y. Epub 2022 Aug 29.
There is considerable variation in the practice of ventral hernia repair (VHR). Consequently, both short- and long-term outcomes are different. We report the first multicenter data from India on the variations in procedures and short-term outcomes after ventral hernia repair.
A prospective study was planned under the aegis of the Indian Association of Gastrointestinal Endo Surgeons (IAGES). Participating surgeons prospectively recorded the data of patients who underwent VHR from January 21, 2021, to April 20, 2021. Patients were followed for 3-6 months.
Data from 648 patients were analyzed for demographics, hernia characteristics, technical variations, and outcomes. 375 (57.8%) were primary hernias (PH) and 273 (42.15%) were incisional hernias (IH), of which 63 (9.7%) were recurrent hernias. In the PH group, there were 171 minimal access (MAS) and 170 open repair. In descending order of frequency, there were 111 (32.6%) open onlay, 83 (24.3%) intraperitoneal onlay meshplasty (IPOM) Plus, 36 (10.6%) IPOM, 35 (10.3%) suture repair, 22 (6.5%) endoscopic Rives Stoppa (eRS), 11 (3.2%) open RS, 11 (3.2%) TAPP, 7 (2%) hybrid, 6 (1.8%) open preperitoneal, 19 (5.6%) others. There were 3.73% seroma, 3.2% SSI, 0% 90-day readmission, 0% recurrence, and 0.3% mortality. In the IH group, 164 patients underwent open repair and 104 MAS repair. In descending order of frequency, there were 90 (33.6%) open onlay, 47 (17.5%) IPOM Plus, 38 (14.1%) open sublay, 28 (10.4%) IPOM, 12 (4.5%) Transversus Abdominis Release (TAR), 11 (4.1%) suture repair, 9 (3.4%) open preperitoneal, 7 (2.6%) hybrid, 6 (2.2%) TAPP, 5 (1.9%) eRS, 4 (1.5%) TARM, 3 (1.1%) endoscopic TAR (eTAR), and 8 (3%) others. There were 13.92% seroma, 4.4% hematoma, 9.5% SSI, 1.1% mesh explantation, 0.4% wound sinus, 2.2% 90-day readmission, 0% recurrence, and 1.1% mortality.
Onlay meshplasty is the commonest procedure in India both in PH and IH. IPOM/IPOM plus is the second commonest procedure. TAR is the preferred component separation technique. Complication rates were comparable to published literature.
The study was registered with Clinical Trial Registry of India. CTRI number-CTRI/2021/01/030435.
腹疝修补术（VHR）的实践存在很大差异。因此，短期和长期结果也各不相同。我们报告了印度首个关于腹疝修补术后手术方式差异和短期结果的多中心数据。
在印度胃肠内镜外科医生协会（IAGES）的支持下开展了一项前瞻性研究。参与研究的外科医生前瞻性记录了2021年1月21日至2021年4月20日期间接受VHR的患者数据。对患者进行了3至6个月的随访。
分析了648例患者的人口统计学、疝的特征、技术差异和结果。375例（57.8%）为原发性疝（PH），273例（42.15%）为切口疝（IH），其中63例（9.7%）为复发性疝。在PH组中，171例采用微创入路（MAS），170例采用开放修补术。按频率从高到低依次为：111例（32.6%）开放补片修补术、83例（24.3%）腹腔内置补片修补术（IPOM）加强型、36例（10.6%）IPOM、35例（10.3%）缝合修补术、22例（6.5%）内镜下Rives Stoppa术（eRS）、11例（3.2%）开放Rives Stoppa术、11例（3.2%）经腹腹膜前修补术（TAPP）、7例（2%）杂交手术、6例（1.8%）开放腹膜前修补术、19例（5.6%）其他手术方式。血清肿发生率为3.73%，手术部位感染（SSI）发生率为3.2%，90天再入院率为0%，复发率为0%，死亡率为0.3%。在IH组中，164例患者接受开放修补术，104例接受MAS修补术。按频率从高到低依次为：90例（33.6%）开放补片修补术、47例（17.5%）IPOM加强型、38例（14.1%）开放腹膜下修补术、28例（10.4%）IPOM、12例（4.5%）腹横肌松解术（TAR）、11例（4.1%）缝合修补术、9例（3.4%）开放腹膜前修补术、7例（2.6%）杂交手术、6例（2.2%）TAPP、5例（1.9%）eRS、4例（1.5%）TARM、3例（1.1%）内镜下TAR（eTAR），8例（3%）其他手术方式。血清肿发生率为13.92%，血肿发生率为4.4%，SSI发生率为9.5%，补片取出率为1.1%，伤口窦道发生率为0.4%，90天再入院率为2.2%，复发率为0%，死亡率为1.1%。
补片修补术在印度无论是原发性疝还是切口疝中都是最常见的手术方式。IPOM/IPOM加强型是第二常见的手术方式。TAR是首选的成分分离技术。并发症发生率与已发表的文献相当。
该研究已在印度临床试验注册中心注册。CTRI编号 - CTRI/2021/01/030435。
