Parker S G, Blake H, Zhao S, van Dellen J, Mohamed S, Albadry W, Akhtar H, Franczak B, Jakkalasaibaba R, Rothnie A, Thomas R
Croydon Health Services NHS Trust, UK.
St George's University Hospitals NHS Foundation Trust, UK.
Ann R Coll Surg Engl. 2024 Jan;106(1):29-35. doi: 10.1308/rcsann.2022.0167. Epub 2023 Mar 16.
Abdominal wall reconstruction (AWR) is an emerging subspecialty within general surgery. The practice of multidisciplinary team (MDT) meetings to aid decision making and improve patient care has been demonstrated, with widespread acceptance. This study presents our initial experience of over 150 cases of complex hernia patients discussed in a newly established MDT setting.
From February 2020 to July 2022 (30-month period), abdominal wall MDTs were held bimonthly. Key stakeholders included upper and lower gastrointestinal surgeons, a gastrointestinal specialist radiologist, a plastic surgeon, a high-risk anaesthetist and two junior doctors integrated into the AWR clinical team. Meetings were held online, where patient history, past medical and surgical history, hernia characteristics and up-to-date computed tomography scans were discussed.
Some 156 patients were discussed over 18 meetings within the above period. Ninety-five (61%) patients were recommended for surgery, and 61 (39%) patients were recommended for conservative management or referred elsewhere. Seventy-eight (82%) patients were directly waitlisted, whereas seventeen (18%) required preoperative optimisation: three (18%) for smoking cessation, eleven (65%) for weight-loss management and three (18%) for specialist diabetic assessment and management. In total, 92 (59%) patients (including operative and nonoperative management) have been discharged to primary care.
A multidisciplinary forum for complex abdominal wall patients is a safe process that facilitates decision making, promotes education and improves patient care. As the AWR subspecialty evolves, our view is that the "complex hernia MDT" will become commonplace. We present our experience and share advice for others planning to establish an AWR centre.
腹壁重建（AWR）是普通外科中一个新兴的亚专业领域。多学科团队（MDT）会议有助于决策制定并改善患者护理，这一做法已得到广泛认可。本研究介绍了我们在新设立的MDT环境中讨论的150多例复杂疝患者的初步经验。
从2020年2月至2022年7月（为期30个月），每两个月举行一次腹壁MDT会议。关键利益相关者包括上、下消化道外科医生、胃肠专科放射科医生、整形外科医生、高危麻醉师以及两名融入AWR临床团队的初级医生。会议通过线上方式举行，会上讨论了患者病史、既往内科和外科病史、疝的特征以及最新的计算机断层扫描结果。
在上述期间的18次会议上共讨论了约156例患者。95例（61%）患者被建议进行手术，61例（39%）患者被建议进行保守治疗或转诊至其他地方。78例（82%）患者直接进入等待名单，而17例（18%）患者需要术前优化：3例（18%）为戒烟，11例（65%）为体重管理，3例（18%）为专科糖尿病评估和管理。共有92例（59%）患者（包括手术和非手术治疗）已出院至基层医疗单位。
为复杂腹壁患者设立的多学科论坛是一个安全的过程，有助于决策制定、促进教育并改善患者护理。随着AWR亚专业的发展，我们认为“复杂疝MDT”将变得司空见惯。我们介绍了我们的经验，并为其他计划建立AWR中心的人分享建议。
