Department of General Surgery, Hospital Universitario Virgen del Rocío, Avda. Manuel Siurot S/N, 41013, Seville, Spain.
Faculty of Education Sciences, Physical Education and Sports, University of Seville, Seville, Spain.
Updates Surg. 2024 Nov;76(7):2611-2616. doi: 10.1007/s13304-024-01997-y. Epub 2024 Sep 19.
Primary ventral hernia repair is a common global surgical procedure, entailing economic burdens and recurrence challenges. Rectus diastasis (RD) is considered a risk factor for midline defects and treatment is symptom-based. When primary ventral hernia and RD coexist, management still remains unclear. This study aims to analyze recurrence rates in patients after umbilical/epigastric hernia repair with untreated diastasis. Observational and retrospective cohort study of 74 patients assessing the recurrence rate of umbilical or epigastric hernias in patients operated with or without RD. Data were obtained from a tertiary hospital's patients between 2015 and 2017. Medium-term recurrences were analyzed after at least 3 year follow up. We compared demographic data, presence of RD (defined as rectus muscles separation exceeding 2 cm), type of repair and surgical complications. Data on 74 patients were collected. The mean age was 57.08 years, and the mean BMI was 31.27 kg/m. Thirty-one included patients were females (42.9%). RD was documented in 67.1% of the sample. Mean follow-up was 4.23 (± 2.53) years. Postoperative complications were predominantly grade 1 according to the Clavien-Dindo classification, with a 17.14% surgical site infection rate. Female gender (p = 0.039), diabetes (0.016), and RD (0.049) showed statistically significant differences in predicting the risk of medium-term recurrence. Patients with untreated RD face a higher risk of medium-term recurrence following primary ventral hernia repair. Additionally, female gender and diabetes were found to be independent risk factors. Prospective studies are recommended to further assist surgeons in choosing the optimal surgical strategy for patients with umbilical hernia and associated RD.
原发性腹侧疝修补术是一种常见的全球外科手术，涉及经济负担和复发挑战。腹直肌分离（RD）被认为是中线缺损的危险因素，治疗基于症状。当原发性腹侧疝和 RD 并存时，其管理仍不清楚。本研究旨在分析未治疗的 RD 对脐疝/上腹部疝修补术后患者复发率的影响。对 74 例患者进行观察性和回顾性队列研究，评估 RD 存在或不存在的患者行脐疝/上腹部疝修补术后脐疝或上腹部疝的复发率。数据来自 2015 年至 2017 年一家三级医院的患者。至少随访 3 年后分析中期复发。我们比较了人口统计学数据、RD 的存在（定义为腹直肌分离超过 2cm）、修复类型和手术并发症。共收集了 74 例患者的数据。平均年龄为 57.08 岁，平均 BMI 为 31.27kg/m。31 例患者为女性（42.9%）。67.1%的样本记录了 RD。平均随访时间为 4.23（±2.53）年。术后并发症主要为 Clavien-Dindo 分级 1 级，手术部位感染率为 17.14%。女性（p=0.039）、糖尿病（0.016）和 RD（0.049）在预测中期复发风险方面存在统计学差异。未治疗 RD 的患者在接受原发性腹侧疝修补术后，面临更高的中期复发风险。此外，女性和糖尿病被发现是独立的危险因素。建议进行前瞻性研究，以进一步帮助外科医生为合并 RD 的脐疝患者选择最佳手术策略。
