开放式无张力疝修补术后应用皮下置网是否可减少手术部位并发症和感染？一项非随机的初步研究。
Do surgical drains reduce surgical site occurrence and infection after incisional hernia repair with sublay mesh? A non-randomised pilot study.
机构信息
Department of General and Digestive Surgery, Hautepierre Hospital, Strasbourg University Hospital, 2 Avenue Molière, 67200, Strasbourg, France.
Streinth Lab (Stress Response and Innovative Therapies), Inserm UMR_S 1113 IRFAC (Interface Recherche Fondamental Et Appliquée À La Cancérologie), Strasbourg University, Strasbourg, France.
出版信息
Hernia. 2023 Aug;27(4):873-881. doi: 10.1007/s10029-023-02768-1. Epub 2023 Mar 24.
INTRODUCTION
Surgical site occurrence (SSO) and surgical site infection (SSI) are common concerns with incisional hernia repair. Intraoperative drain placement is a common practice aiming to reduce SSO and SSI rates. However, literature on the matter is very poor. The aim of this study is to investigate the role of subcutaneous and periprosthetic drain placement on postoperative outcomes and SSO and SSI rates with incisional hernia repair.
METHODS
A non-randomised pilot study was performed between January 2018 and December 2020 and included patients with elective midline or lateral incisional hernia repair with sublay mesh placement. Patients were prospectively included, followed for 1 month and divided into three groups: group 1 without drainage, group 2 with subcutaneous drainage, and group 3 with subcutaneous and periprosthetic drains. Drains were placed at surgeon's discretion. All patients were included in the enhanced recovery program.
RESULTS
One hundred and four patients were included. Twenty-four patients (23.1%) did not have drains (group 1), 60 patients (57.7%) had a subcutaneous drain (group 2) and 20 patients (19.2%) had both a subcutaneous and a periprosthetic drains (group 3). SSO rates were significantly different between the 3 groups: 20.8% in group 1, 20.7% in group 2 and 50% in group 3 (p = 0.03). There was no significant difference in deep and superficial SSI rates between the 3 groups. Subgroup analysis revealed that adding a drain in direct contact with the mesh significantly increased SSO rate but did not influence SSI rate. Length of stay was also significantly increased by the presence of a drain, 3.1 ± 1.9 days for group 1; 5.9 ± 4.8 for group 2 and 5.9 ± 2.5 days for group 3 (p < 0.005).
CONCLUSION
Drain placement in direct contact with the mesh might increase SSO rate. More studies are necessary to evaluate the actual benefits of drainage after incisional hernia repair.
引言
手术部位发生（SSO）和手术部位感染（SSI）是切口疝修补术常见的关注点。术中放置引流管是一种常见的做法，旨在降低 SSO 和 SSI 发生率。然而，相关文献非常有限。本研究旨在探讨切口疝修补术中皮下和假体周围引流管放置对术后结果和 SSO 和 SSI 发生率的影响。
方法
一项非随机试点研究于 2018 年 1 月至 2020 年 12 月进行，纳入了接受中线或侧切口疝修补术和网片修补术的择期患者。前瞻性纳入患者，随访 1 个月，并分为三组：无引流组（1 组）、皮下引流组（2 组）和皮下及假体周围引流组（3 组）。引流管由术者决定放置。所有患者均纳入加速康复方案。
结果
共纳入 104 例患者。24 例患者（23.1%）未放置引流管（1 组），60 例患者（57.7%）放置皮下引流管（2 组），20 例患者（19.2%）放置皮下和假体周围引流管（3 组）。3 组 SSO 发生率差异有统计学意义：1 组为 20.8%，2 组为 20.7%，3 组为 50%（p=0.03）。3 组深部和浅部 SSI 发生率差异无统计学意义。亚组分析显示，与网片直接接触的引流管增加 SSO 发生率，但不影响 SSI 发生率。引流管的存在也显著延长了住院时间，1 组为 3.1±1.9 天，2 组为 5.9±4.8 天，3 组为 5.9±2.5 天（p<0.005）。
结论
与网片直接接触的引流管放置可能会增加 SSO 发生率。需要进一步研究来评估切口疝修补术后引流的实际获益。
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