Postgraduate Program in Surgical Sciences, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
Hospital Municipal de Pronto Socorro de Porto Alegre (HPS), Largo Theodoro Hertlz, Porto Alegre, Porto Alegre, Rio Grande do Sul, 90040-194, Brazil.
Langenbecks Arch Surg. 2023 Jan 20;408(1):48. doi: 10.1007/s00423-023-02802-x.
To compare the incidence of surgical site occurrences (SSOs) following onlay versus preperitoneal mesh placement in elective open umbilical hernia repairs.
This study presents a secondary analysis of a randomized double-blind trial conducted on female patients with primary umbilical hernias admitted to a general hospital, in a residency training program setting. Fifty-six subjects were randomly assigned to either onlay (n=30) or preperitoneal (n=26) mesh repair group. Data on baseline demographics, past medical history, perioperative details, postoperative pain (visual analogue scale (VAS)), wound-related complications, and recurrence were assessed using a standardized protocol.
No statistically significant differences were observed between groups regarding patients' demographics, comorbidities, or defect size. Operative time averaged 67.5 (28-110) min for onlay and 50.5 (31-90) min for preperitoneal repairs, p=.03. The overall rate of SSOs was 21.4% (n=12), mainly in the onlay group (33% vs 7.7%; p=0.02, 95% CI 0.03-0.85) and mostly due to seromas. There were no between-group significant differences in postoperative VAS scores at all timepoints. After a maximum follow-up of 48 months, one recurrence was reported in the onlay group. By logistic regression, the onlay technique was the only independent risk factor for SSOs.
The presented data identified a decreased wound morbidity in preperitoneal umbilical hernia repairs, thus contributing to the limited body of evidence regarding mesh place selection in future guidelines. Further cases from this ongoing study and completion of follow-up are expected to also compare both techniques in terms of long-term outcomes.
Brazilian Registry of Clinical Trials (ReBEC) UTN code: U1111-1205-0065 (date of registration: March 27, 2018).
比较外侧和腹膜前网片修补术治疗择期开放脐疝术后手术部位并发症（SSO）的发生率。
本研究为女性原发性脐疝患者随机双盲临床试验的二次分析，患者入组于一家综合医院的住院医师培训项目中。56 名患者随机分为外侧（n=30）或腹膜前（n=26）网片修补组。采用标准化方案评估基线人口统计学、既往病史、围手术期细节、术后疼痛（视觉模拟评分（VAS））、伤口相关并发症和复发情况。
两组患者的人口统计学、合并症或缺损大小均无统计学差异。外侧组手术时间平均为 67.5（28-110）min，腹膜前组为 50.5（31-90）min，p=.03。SSO 总发生率为 21.4%（n=12），主要发生在外侧组（33%比 7.7%；p=0.02，95%CI 0.03-0.85），主要为血清肿。所有时间点两组术后 VAS 评分均无统计学差异。在最长 48 个月的随访中，外侧组有 1 例复发。通过逻辑回归，外侧技术是 SSO 的唯一独立危险因素。
本研究数据表明，腹膜前脐疝修补术可降低伤口并发症，从而为未来指南中关于网片选择的有限证据做出贡献。该正在进行的研究将增加更多病例，并在完成随访后，比较两种技术的长期结果。
巴西临床试验注册中心（ReBEC）UTN 编号：U1111-1205-0065（注册日期：2018 年 3 月 27 日）。
