Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Center for Perioperative Optimization, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark; The Danish Hernia Database, Copenhagen, Denmark.
Surgery. 2024 Dec;176(6):1676-1682. doi: 10.1016/j.surg.2024.09.003. Epub 2024 Oct 5.
Ventral hernias of umbilical, epigastric, and incisional types pose varied surgical challenges. Recent debates and research suggest that treatment strategies and outcomes may vary significantly based on hernia type and width. This study investigated whether differences in the risk of surgical outcomes among primary and incisional hernias are solely due to the hernia type. The primary outcome was reoperation for recurrence, and the secondary outcome was 90-day postoperative readmission.
This study was based on prospectively collected data from the Danish Ventral Hernia Database linked with the Danish Civil Registration system and the National Patient Register. Data spanned from 2007 to 2022 and included patients with umbilical, epigastric, or incisional hernias. The 3 hernia types were analyzed for the risk of reoperation for recurrence, adjusted for sex, age, emergency repair, width, use of mesh, and Charlson comorbidity index.
We included 57,312 hernias: 34,147 umbilical, 9,433 epigastric, and 13,722 incisional hernias. Compared with patients with umbilical hernias, patients with epigastric hernias had a lower risk of reoperation (hazard ratio: 0.88, 95% confidence interval: 0.79-0.99) and those with incisional hernias had an increased risk (hazard ratio: 2.93, 95% confidence interval: 2.57-3.33). Postoperative 90-day readmission rates were also higher for patients with incisional hernias than for patients with umbilical and epigastric hernias.
Incisional hernias exhibited a higher risk of reoperation for recurrence and 90-day postoperative readmission, underscoring their unique nature in terms of both origin and clinical behavior. The findings suggest that primary and incisional hernias should be separate entities in medical practice and research.
脐疝、上腹疝和切口疝的外科治疗具有不同的挑战性。最近的争论和研究表明，治疗策略和结果可能因疝类型和宽度而有很大差异。本研究旨在探讨原发性和切口疝患者手术结果风险的差异是否仅归因于疝类型。主要结局是复发再手术，次要结局是术后 90 天再次入院。
本研究基于丹麦腹疝数据库前瞻性收集的数据，该数据库与丹麦民事登记系统和国家患者登记处相链接。数据涵盖了 2007 年至 2022 年期间的患者，包括脐疝、上腹疝和切口疝患者。对 3 种疝类型进行了分析，以确定复发再手术的风险，调整了性别、年龄、急诊修复、宽度、使用网片和 Charlson 合并症指数。
我们纳入了 57312 例疝：34147 例脐疝、9433 例上腹疝和 13722 例切口疝。与脐疝患者相比，上腹疝患者复发再手术的风险较低（风险比：0.88，95%置信区间：0.79-0.99），切口疝患者的风险较高（风险比：2.93，95%置信区间：2.57-3.33）。切口疝患者术后 90 天再次入院率也高于脐疝和上腹疝患者。
切口疝的复发再手术风险和术后 90 天再次入院率较高，突出了其在起源和临床行为方面的独特性。研究结果表明，在医疗实践和研究中，原发性和切口疝应该是两个独立的实体。
