Center for Abdominal Core Health, Cleveland Clinic, 2049 E 100th St, Desk A-100, Cleveland, OH, 44106, USA.
Weill Cornell Medicine, New York, USA.
Surg Endosc. 2024 Apr;38(4):2019-2026. doi: 10.1007/s00464-024-10716-y. Epub 2024 Feb 29.
Intraperitoneal onlay mesh (IPOM) placement for small to medium-sized hernias has garnered negative attention due to perceived long-term risk of mesh-related complications. However, sparse data exists supporting such claims after minimally invasive (MIS) IPOM repairs and most is hindered by the lack of long-term follow-up. We sought to report long-term outcomes and mesh-related complications of MIS IPOM ventral hernia repairs.
Adult patients who underwent MIS IPOM ventral hernia repair at our institution were identified in the Abdominal Core Health Quality Collaborative database from October 2013 to October 2020. Outcomes included hernia recurrence and mesh-related complications or reoperations up to 6 years postoperatively.
A total of 325 patients were identified. The majority (97.2%) of cases were elective, non-recurrent (74.5%), and CDC class I (99.4%). Mean hernia width was 4.16 ± 3.86 cm. Median follow-up was 3.6 (IQR 2.8-5) years. Surgeon-entered or patient-reported follow-up was available for 253 (77.8%) patients at 3 years or greater postoperatively. One patient experienced an early small bowel obstruction and was reoperated on within 30 days. Two-hundred forty-five radiographic examinations were available up to 6 years postoperatively. Twenty-seven patients had hernia recurrence on radiographic examination up to 6 years postoperatively. During long-term follow-up, two mesh-related complications required reoperations: mesh removed for chronic pain and mesh removal at the time of colon surgery for perforated cancer. Sixteen additional patients required reoperation within 6 years for the following reasons: hernia recurrence (n = 5), unrelated intraabdominal pathology (n = 9), obstructed port site hernia (n = 1), and adhesive bowel obstruction unrelated to the prosthesis (n = 1). The rate of reoperation due to intraperitoneal mesh complications was 0.62% (2/325) with up to 6 year follow-up.
Intraperitoneal mesh for repair of small to medium-sized hernias has an extremely low rate of long-term mesh-related complications. It remains a safe and durable option for hernia surgeons.
由于对与网片相关的并发症的长期风险的认识，用于小至中等大小疝的腹腔内补片（IPOM）放置引起了负面关注。然而，微创（MIS）IPOM 修复后的支持此类说法的数据很少，而且大多数数据都受到缺乏长期随访的限制。我们旨在报告 MIS IPOM 腹疝修复的长期结果和与网片相关的并发症。
在我们的腹部核心健康质量协作数据库中，从 2013 年 10 月至 2020 年 10 月，确定了在我们机构接受 MIS IPOM 腹疝修复的成年患者。结果包括术后 6 年内疝复发和与网片相关的并发症或再次手术。
共确定了 325 例患者。大多数（97.2%）病例为择期、非复发性（74.5%）和 CDC Ⅰ级（99.4%）。平均疝宽为 4.16±3.86cm。中位随访时间为 3.6（IQR 2.8-5）年。在术后 3 年或更长时间，有 253（77.8%）例患者可获得外科医生或患者报告的随访。1 例患者术后 30 天内发生早期小肠梗阻并再次手术。245 例患者可获得术后 6 年内的 245 次放射学检查。27 例患者在术后 6 年内通过放射学检查发现疝复发。在长期随访中，有 2 例与网片相关的并发症需要再次手术：因慢性疼痛而切除网片和因穿孔性癌症而切除网片。在 6 年内，另外 16 例患者因以下原因需要再次手术：疝复发（n=5）、腹腔内非相关病变（n=9）、端口疝阻塞（n=1）和与假体无关的粘连性肠梗阻（n=1）。在有 6 年随访的情况下，因腹腔内网片并发症而再次手术的发生率为 0.62%（2/325）。
用于修复小至中等大小疝的腹腔内网片具有极低的长期网片相关并发症发生率。它仍然是疝外科医生的安全且持久的选择。
