Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
General Surgery Division, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
Hernia. 2024 Aug;28(4):1397-1404. doi: 10.1007/s10029-024-03067-z. Epub 2024 May 12.
Incisional hernias (IH) are a significant postoperative complication with profound implications for patient morbidity and healthcare costs. The relationship between IH and perioperative factors in pancreatic surgery, with particular attention to preoperative biliary stents and pancreatic fistulas requires further exploration.
This retrospective observational study examined adult patients who underwent open pancreatic surgeries via midline incision at a high-volume tertiary hepatopancreatobiliary center from January 2008 to December 2021. The study focused on IH incidence and associated risk factors, with particular attention to preoperative biliary stents and pancreatic fistulas.
In a cohort of 620 individuals undergoing pancreatic surgery, 351 had open surgery with at least one-year follow-up. Within a median follow-up of 794 days (IQR 1694-537), the overall incidence of IH was 17.38%. The highest frequency of IH was observed among patients who had a Pancreaticoduodenectomy (PD). Significant predictors for the development of IH within the entire study population in a multivariable analysis included perioperative biliary stenting (OR 2.05; 95% CI 1.06-3.96; p = 0.03), increased age at diagnosis (OR 2.05; 95% CI 1.06-3.96; p = 0.01), and BMI (OR 1.08; 95% CI 1.01-1.15; p = 0.01). In the subset of patients who underwent Pancreaticoduodenectomy (PD), although the presence of biliary stents was associated with a heightened occurrence of SSIs, it did not demonstrate a direct correlation with an increased incidence of incisional hernias (IH). The development of pancreatic fistulas did not show a significant correlation with IH in either the Distal Pancreatectomy with Splenectomy (DPS) or the PD patient groups.
The study underscores a notable association between biliary stent placement and increased IH risk after PD, mediated by elevated SSI incidence. Pancreatic fistulas were not directly correlated with IH in the studied cohorts. Further research is necessary to validate these findings and guide clinical practice.
切口疝（IH）是一种术后严重的并发症，对患者的发病率和医疗保健成本有深远影响。在胰腺手术中，IH 与围手术期因素之间的关系，特别是术前胆道支架和胰瘘，需要进一步探讨。
本回顾性观察研究对 2008 年 1 月至 2021 年 12 月在一家高容量的三级肝胆胰中心接受中线切口开放胰腺手术的成年患者进行了研究。研究重点是 IH 的发生率和相关的危险因素，特别关注术前胆道支架和胰瘘。
在 620 名接受胰腺手术的患者中，有 351 名接受了开放手术，并至少随访了一年。在中位随访 794 天（IQR 1694-537）内，IH 的总发生率为 17.38%。在整个研究人群中，接受胰十二指肠切除术（PD）的患者 IH 发生率最高。多变量分析中，整个研究人群中 IH 发生的显著预测因素包括围手术期胆道支架（OR 2.05；95%CI 1.06-3.96；p=0.03）、诊断时年龄增加（OR 2.05；95%CI 1.06-3.96；p=0.01）和 BMI（OR 1.08；95%CI 1.01-1.15；p=0.01）。在接受胰十二指肠切除术（PD）的患者亚组中，尽管胆道支架的存在与 SSIs 的发生率升高相关，但与 IH 发生率的升高没有直接相关性。在胰体尾切除术（DPS）或 PD 患者组中，胰瘘的发生与 IH 也没有显著相关性。
该研究强调了 PD 后胆道支架放置与 IH 风险增加之间的显著关联，这是通过 SSIs 发生率升高介导的。在研究队列中，胰瘘与 IH 没有直接相关性。需要进一步的研究来验证这些发现并指导临床实践。
