van den Berg Rudolf, van den Dop L Matthijs, Timmermans Lucas, van den Berg Michiel, Pierik Robert E G J M, Zwaans Willem A R, Reim Daniel, Buijk Steven E, van Brussel Jerome P, Lange Johan F, Jeekel Johannes J, Tanis Pieter J
Department of Surgery, Erasmus University Medical Centre, Rotterdam, The Netherlands.
Department of Surgery, Radboud University Hospital, Nijmegen, The Netherlands.
Ann Surg. 2024 Sep 6. doi: 10.1097/SLA.0000000000006527.
This study aimed to evaluate all mesh-related problems during reoperations after mesh-reinforcement 15 years after the start of the PRIMA trial. SUMMARY BACKGROUND DATA Prophylactic mesh reinforcement during closure of a midline laparotomy has proven to reduce the incidence of incisional hernia, especially in high-risk patients, but long-term mesh-related morbidity is largely unknown.
Patients receiving a prophylactic onlay or retro-rectus mesh in the PRIMA trial between 2009 and 2012 were included on an as-treated basis from participating centers that made reoperation notes available. Main outcomes were the incidences of complications requiring mesh explantation, mesh-related ileus, and mesh-related problems during laparotomy for other diagnoses.
Out of 373 patients randomized to prophylactic mesh reinforcement, 242 were included: 127 with onlay and 115 patients with retrorectus mesh. Median follow-up is 27 months (IQR 12-78). Thirty-four patients underwent reoperation for any reason during entire follow-up, 22 after onlay (17.3%) and 12 after retrorectus mesh (10.4%). Reoperation rate for complications that required mesh explantation was 4/127 (3.1%) after onlay and 0/115 (0%) after retrorectus mesh. Mesh-related ileus occurred in none of the onlay group, and 3/115 (2.6%) in the retrorectus group. During subsequent laparotomies for other primary diagnoses, adhesions to the mesh were noted in 3/10 patients in the onlay group and 1/5 patients in the retro-rectus group. Overall, the mesh was removed in 10/127 (7.9%) in the onlay group and 7/115 (6.1%) patients in the retro-rectus group.
In high-risk patients receiving a prophylactic mesh during midline laparotomy closure, low incidences of mesh-related complications requiring reoperation and mesh-related problems during unrelated subsequent laparotomies were found, for both the onlay and retrorectus techniques.
本研究旨在评估PRIMA试验开始15年后再次手术期间所有与补片相关的问题。总结背景数据 中线剖腹手术关闭时进行预防性补片加强已被证明可降低切口疝的发生率，尤其是在高危患者中，但长期与补片相关的发病率在很大程度上尚不清楚。
在2009年至2012年PRIMA试验中接受预防性外置或腹直肌后补片的患者，根据提供再次手术记录的参与中心的实际治疗情况纳入研究。主要结局是需要取出补片的并发症、与补片相关的肠梗阻以及因其他诊断进行剖腹手术期间与补片相关问题的发生率。
在373例随机接受预防性补片加强的患者中，242例被纳入：127例接受外置补片，115例接受腹直肌后补片。中位随访时间为27个月（四分位间距12 - 78个月）。在整个随访期间，34例患者因任何原因接受了再次手术，外置补片后22例（17.3%），腹直肌后补片后12例（10.4%）。需要取出补片的并发症再次手术率在外置补片后为4/127（3.1%），腹直肌后补片后为0/115（0%）。外置补片组无一例发生与补片相关的肠梗阻，腹直肌后补片组有3/115（2.6%）发生。在随后因其他主要诊断进行的剖腹手术中，外置补片组10例中有3例、腹直肌后补片组5例中有1例发现与补片粘连。总体而言，外置补片组10/127（7.9%）、腹直肌后补片组7/115（6.1%）的患者补片被取出。
对于中线剖腹手术关闭时接受预防性补片的高危患者，外置和腹直肌后补片技术在需要再次手术的与补片相关并发症以及无关的后续剖腹手术期间与补片相关问题的发生率均较低。
