Soliani Giorgio, De Troia Alessandro, Pesce Antonio, Portinari Mattia, Fabbri Nicolò, Leonardi Luca, Neri Silvia, Carcoforo Paolo, Feo Carlo V
Department of Surgery, S. Anna University Hospital and University of Ferrara, Ferrara, Italy.
Department of Surgery, Azienda USL of Ferrara, University of Ferrara, Ferrara, Italy.
J Laparoendosc Adv Surg Tech A. 2023 May;33(5):427-433. doi: 10.1089/lap.2022.0465. Epub 2023 Jan 20.
The main purpose of this study was to analyze patient-related factors that may influence the risk of hernia recurrence following laparoscopic incisional hernia repair (LIHR), including the potential role of chosen materials. A multicenter, retrospective cohort study was conducted on all patients who were aged >18 years and who underwent elective laparoscopic incisional hernia mesh repair at the Departments of Surgery of the S. Anna University Hospital in Ferrara and Sassuolo Hospital in Modena, Italy. Exclusion criteria were as follows: patients undergoing an open or emergency incisional hernia repair or with primary ventral hernia. All hernia and operative variables that may favor hernia recurrence were collected and analyzed. Follow-up was conducted through a standardized telephone interview, followed by an outpatient visit and diagnostic imaging if needed. From September 2002 to September 2017, 312 consecutive patients underwent elective laparoscopic incisional hernia mesh repair. At a mean 22-month follow-up, 273 patients presented no recurrence of incisional hernia and 39 had relapsed. Intra- and postoperative complications were similar between groups. Unadjusted Cox regression analysis showed a statistically significant association between both the partially absorbable mesh ( < .0001) and absorbable tacks ( = .001) and recurrence, while after adjusting for potential confounders, only the partially absorbable mesh was significantly associated with recurrence ( = .007). The laparoscopic approach may be considered safe for incisional hernia mesh repair. In this multicenter, retrospective cohort study, the use of a partially absorbable mesh in LIHR was the only predictor of hernia recurrence. The partially absorbable mesh that was investigated, however, has been withdrawn from the market.
本研究的主要目的是分析可能影响腹腔镜切口疝修补术（LIHR）后疝复发风险的患者相关因素，包括所选材料的潜在作用。对意大利费拉拉圣安娜大学医院和摩德纳萨索洛医院外科所有年龄>18岁且接受择期腹腔镜切口疝修补术的患者进行了一项多中心回顾性队列研究。排除标准如下：接受开放或急诊切口疝修补术的患者或原发性腹疝患者。收集并分析了所有可能导致疝复发的疝和手术变量。通过标准化电话访谈进行随访，必要时进行门诊就诊和诊断性影像学检查。2002年9月至2017年9月，312例连续患者接受了择期腹腔镜切口疝修补术。平均随访22个月时，273例患者切口疝未复发，39例复发。两组的术中及术后并发症相似。未调整的Cox回归分析显示，部分可吸收补片（<0.0001）和可吸收钉（=0.001）与复发均有统计学显著关联，而在调整潜在混杂因素后，只有部分可吸收补片与复发显著相关（=0.007）。腹腔镜手术方法可被认为对切口疝修补术是安全的。在这项多中心回顾性队列研究中，LIHR中使用部分可吸收补片是疝复发的唯一预测因素。然而，所研究的部分可吸收补片已退出市场。
