Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.
Surg Endosc. 2023 Dec;37(12):9476-9482. doi: 10.1007/s00464-023-10348-8. Epub 2023 Sep 11.
Sufficient overlap of mesh beyond the borders of a ventral hernia helps prevent hernia recurrence. Guidelines from the European Hernia Society and American Hernia Society recommend ≥ 2 cm overlap for open repair of < 1-cm hernias, ≥ 3-cm overlap for open repair of 1-4-cm hernias, ≥ 5-cm overlap for open repair of > 4-cm hernias, and ≥ 5-cm overlap for all laparoscopic ventral hernia repairs. We evaluated whether current practice reflects this guidance.
We used the Michigan Surgical Quality Collaborative Hernia Registry to evaluate patients who underwent elective ventral and umbilical hernia repair between 2020 and 2022. Mesh overlap was calculated as [(width of mesh - width of hernia)/2]. The main outcome was "sufficient overlap," defined based on published EHS and AHS guidelines. Explanatory variables included patient, operative, and hernia characteristics. The main analysis was a multivariable logistic regression to evaluate the association between explanatory variables and sufficient mesh overlap.
4178 patients underwent ventral hernia repair with a mean age of 55.2 (13.9) years, 1739 (41.6%) females, mean body mass index (BMI) of 33.1 (7.2) kg/m, and mean hernia width of 3.7 (3.4) cm. Mean mesh overlap was 3.7 (2.5) cm and ranged from - 5.5 to 21.4 cm. Only 1074 (25.7%) ventral hernia repairs had sufficient mesh overlap according to published guidelines. Operative factors associated with increased odds of sufficient overlap included myofascial release (adjusted odds ratio [aOR] 5.35 [95% CI 4.07-7.03]), minimally invasive approach (aOR 1.86 [95% CI 1.60-2.17]), and onlay mesh location (aOR 1.31 [95% CI 1.07-1.59]). Patient factors associated with increased odds of sufficient overlap included prior hernia repair (aOR 1.59 [95% CI 1.32-1.92]).
Although sufficient mesh overlap is recommended to prevent ventral hernia recurrence, only a quarter of ventral hernia repairs in a state-wide cohort of patients had sufficient overlap according to evidence-based guidelines. Factors strongly associated with sufficient overlap included myofascial release, mesh type, and laparoscopic repair.
足够的网片超出腹疝边界的重叠有助于防止疝复发。欧洲疝学会和美国疝学会的指南建议对于<1cm 的疝开放修补术，重叠>2cm；对于 1-4cm 的疝开放修补术，重叠>3cm；对于>4cm 的疝开放修补术，重叠>5cm；对于所有腹腔镜腹疝修补术，重叠>5cm。我们评估了目前的实践是否反映了这一指导原则。
我们使用密歇根州外科学术质量协作疝登记处，评估了 2020 年至 2022 年间行择期腹疝和脐疝修补术的患者。网片重叠度的计算方法为[(网片宽度-疝宽度)/2]。主要结局是“足够的重叠”，基于发表的 EHS 和 AHS 指南定义。解释性变量包括患者、手术和疝特征。主要分析是多变量逻辑回归，以评估解释性变量与足够的网片重叠之间的关系。
4178 例患者行腹疝修补术，平均年龄 55.2(13.9)岁，女性 1739 例(41.6%)，平均体重指数(BMI)33.1(7.2)kg/m，平均疝宽度 3.7(3.4)cm。网片重叠平均为 3.7(2.5)cm，范围为-5.5 至 21.4cm。只有 1074 例(25.7%)腹疝修补术根据发表的指南有足够的网片重叠。与足够重叠相关的手术因素包括筋膜松解术(校正比值比[OR]5.35[95%可信区间 4.07-7.03])、微创入路(OR 1.86[95%可信区间 1.60-2.17])和网片置放位置(OR 1.31[95%可信区间 1.07-1.59])。与足够重叠相关的患者因素包括既往疝修补术(OR 1.59[95%可信区间 1.32-1.92])。
尽管有足够的网片重叠以预防腹疝复发，但在全州范围内的患者队列中，根据循证指南，只有四分之一的腹疝修补术有足够的重叠。与足够重叠密切相关的因素包括筋膜松解术、网片类型和腹腔镜修补术。
