Bravo-Salva A, Sancho-Insenser J J, Pera-Román M, Pereira-Rodriguez J A
General and Digestive Surgery Department, Parc de Salut Mar, Hospital del Mar, Barcelona, Spain.
Department of Experimental and Health Science, Pompeu Fabra University, Barcelona, Spain.
J Abdom Wall Surg. 2022 Mar 23;1:10030. doi: 10.3389/jaws.2022.10030. eCollection 2022.
: Due to extension of prophylactic mesh indications use will become more common to find patients receiving an iterative laparotomy (IL) over a previous reinforced abdominal wall. The aim of this study was to analyze outcomes after IL in patients with previous mesh reinforcement. This study was a prospective secondary analysis of midline laparotomy closure performed from July 2017 to July 2018 registered in PHACPA study (NCT02658955). IL were included and surgery characteristics and outcomes analyzed. We compared two groups: with (PreM) or without previous prophylactic onlay mesh reinforcement (PreS) Subgroups' analysis, risk factors for complications and survival free hernia analysis were performed. 121 IL were analyzed. Only obesity was associated with higher SSO (OR 2.6; CI 95% 1.02-6.90; = 0.04) There were 15 incisional hernias (IH) (14.4%). Group with previous mesh reinforcement (pre M) had a higher statistically significative incidence of IH (OR = 1.21; CI 95% 1.05-1.39; = 0.015). Use of slowly absorbable suture (OR = 0.74; CI 95% 0.60-0.91; = 0.001), USP 2/0 suture (OR, 0.31; 95% CI, 0.10-0.94; = 0.033), and technique (OR = 0.81; CI 95% 0.72-0.90; = 0.011) were associated with less IH. : IL has a high percentage of complications and IH. In case of IL without previous reinforcement, a mesh can help to reduce IH. Our data cannot clearly support any technique to close an IL with previous mesh.
由于预防性补片适应证的扩展，接受过强化腹壁手术的患者再次接受剖腹手术（IL）的情况将变得更加常见。本研究的目的是分析既往有补片强化的患者接受IL后的结局。本研究是对2017年7月至2018年7月在PHACPA研究（NCT02658955）中登记的中线剖腹手术关闭情况进行的前瞻性二次分析。纳入IL患者并分析手术特征和结局。我们比较了两组：有（PreM）或无既往预防性覆盖补片强化（PreS）。进行亚组分析、并发症危险因素分析和无疝生存分析。分析了121例IL患者。仅肥胖与较高的手术部位感染（SSO）相关（OR 2.6；95%CI 1.02 - 6.90；P = 0.04）。有15例切口疝（IH）（14.4%）。既往有补片强化的组（pre M）IH的发生率在统计学上显著更高（OR = 1.21；95%CI 1.05 - 1.39；P = 0.015）。使用可缓慢吸收缝线（OR = 0.74；95%CI 0.60 - 0.91；P = 0.001）、USP 2/0缝线（OR，0.31；95%CI，0.10 - 0.94；P = 0.033）和技术（OR = 0.81；95%CI 0.72 - 0.90；P = 0.011）与较少的IH相关。IL有较高的并发症和IH发生率。对于既往未强化的IL，补片有助于减少IH。我们的数据不能明确支持任何用于关闭既往有补片的IL的技术。
