Bashian Elizabeth, Daoud Georges, Khansa Ibrahim, Janis Jeffrey E
From The Ohio State University College of Medicine.
Department of Plastic and Reconstructive Surgery, The Ohio State University.
Plast Reconstr Surg. 2023 Mar 1;151(3):646-650. doi: 10.1097/PRS.0000000000009931. Epub 2022 Nov 29.
Mesh repair has been demonstrated to be superior to suture alone in ventral hernia repair. In a previous short-term pilot study, the authors found lower postoperative narcotic requirements with self-adhering mesh. The aim of this study was to follow-up on that pilot study, using long-term data.
This is a retrospective review of a prospectively collected database. All patients who underwent ventral hernia repair with retrorectus mesh and who had at least a 12-month follow-up were reviewed. Comparisons were performed between patients who received self-adhering mesh and those who received transfascially sutured mesh, using matched-pair analysis, examining perioperative outcomes, surgical-site occurrences, and hernia recurrence/bulge.
Forty-two patients were included in the study, with 21 patients undergoing repair with transfascially sutured mesh and 21 patients receiving self-adhering mesh. Average length of follow-up was 1078 days. There were no significant differences between the two groups in baseline characteristics. Patients receiving self-adhering mesh had significantly shorter surgery, and a shorter hospital length of stay. They also had a tendency toward lower narcotic requirements. There were no significant differences in the rate of surgical-site occurrences, hernia recurrences, or bulge between the two groups.
This long-term study shows that self-adhering mesh in ventral hernia repair results in similar long-term outcomes to transfascially sutured mesh, with shorter surgery, shorter length of stay, and a tendency toward improved pain control. These findings mirror the known advantages of self-adhering mesh in inguinal hernia repair. Further research is needed to study the incidence of chronic pain and the cost-effectiveness of self-adhering mesh.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在腹疝修补术中，补片修补已被证明优于单纯缝合。在之前的一项短期试点研究中，作者发现使用自粘补片术后对麻醉剂的需求较低。本研究的目的是利用长期数据对该试点研究进行随访。
这是一项对前瞻性收集的数据库进行的回顾性研究。对所有接受经腹直肌后补片腹疝修补术且至少随访12个月的患者进行了评估。采用配对分析，对接受自粘补片和经筋膜缝合补片的患者进行比较，观察围手术期结果、手术部位情况以及疝复发/膨出情况。
本研究纳入了42例患者，其中21例接受经筋膜缝合补片修补，21例接受自粘补片修补。平均随访时间为1078天。两组患者的基线特征无显著差异。接受自粘补片的患者手术时间明显更短，住院时间也更短。他们对麻醉剂的需求也有降低的趋势。两组患者在手术部位情况发生率、疝复发率或膨出方面无显著差异。
这项长期研究表明，腹疝修补术中使用自粘补片与经筋膜缝合补片的长期效果相似，但手术时间更短、住院时间更短，且在疼痛控制方面有改善的趋势。这些发现反映了自粘补片在腹股沟疝修补术中已知的优势。需要进一步研究慢性疼痛的发生率以及自粘补片的成本效益。
临床问题/证据水平：治疗性，III级
