Hayden Anna, Worth Samantha, Kothari Brittany, Keller Weston, McGill Emily, Blackhurst Dawn, Cobb William S, Carbonell Alfredo M, Warren Jeremy A
University of South Carolina School of Medicine Greenville, USA.
Summer Program for Undergraduate Research in Surgery, Prisma Health Department of Surgery, USA.
Am J Surg. 2023 Dec;226(6):896-900. doi: 10.1016/j.amjsurg.2023.07.044. Epub 2023 Aug 4.
Nearly 20% of ventral hernia repair (VHR) patients require a subsequent abdominal operation (SAO), and mesh position may impact the complexity and outcome of the SAO.
Retrospective review of VHR with mesh from 2006 to 2020 from an internal database and the ACHQC. Primary outcomes measured incidence, complexity, and complications of SAO relative to mesh position.
SAO was required in 433 of 2539 (17.1%) patients, totaling 671 operations; 197/893 (22.1%) with intraperitoneal mesh (IPM) and 236/1646 (14.3%) with extraperitoneal mesh (EPM; p < 0.001). SAO was directly related to VHR in 180 (232 total SAOs) and unrelated in 253 (439 total SAOs). There were no significant differences in complications after SAO between IPM and EPM, nor any difference in adhesion complexity.
Incidence of SAO is higher with IPM, but surgical outcomes are similar. Due to the risk of secondary mesh infection with IPM, significantly more of these were removed at the time of SAO.
近20%的腹疝修补术（VHR）患者需要进行后续腹部手术（SAO），补片位置可能会影响SAO的复杂性和结果。
对2006年至2020年来自内部数据库和ACHQC的使用补片的VHR进行回顾性研究。主要结局指标为相对于补片位置的SAO发生率、复杂性和并发症。
2539例患者中有433例（17.1%）需要进行SAO，共计671次手术；197/893例（22.1%）使用腹腔内补片（IPM），236/1646例（14.3%）使用腹膜外补片（EPM；p<0.001）。180例（共232次SAO）的SAO与VHR直接相关，253例（共439次SAO）无关。IPM和EPM术后并发症无显著差异，粘连复杂性也无差异。
IPM的SAO发生率较高，但手术结果相似。由于IPM存在继发补片感染的风险，在SAO时更多的此类补片被移除。
