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使用可吸收-永久性混合腹膜前补片修复腹疝

Ventral Hernia Repair With a Hybrid Absorbable-permanent Preperitoneal Mesh.

作者信息

Goldblatt Matthew I, Reynolds Matthew, Doerhoff Carl R, LeBlanc Karl, Leyba Mario, Mallico Eric J, Linn John G

机构信息

Department of Surgery, Medical College of Wisconsin, Milwaukee, WI.

HCA Florida Healthcare, Largo, FL.

出版信息

Surg Laparosc Endosc Percutan Tech. 2024 Dec 1;34(6):596-602. doi: 10.1097/SLE.0000000000001327.

Abstract

OBJECTIVE

To analyze device safety and clinical outcomes of ventral hernia repair with the GORE SYNECOR Preperitoneal Biomaterial (PRE device), a permanent high-strength mesh with bioabsorbable web scaffold technology.

MATERIALS AND METHODS

This multicenter retrospective review analyzed device/procedure endpoints and patient-reported outcomes in patients treated for hernia repair ≥1 year from study enrollment.

RESULTS

Included in this analysis were 148 patients with a mean age of 56 years; 66.2% met the Ventral Hernia Working Group grade 2 classification. Median hernia size was 30.0 cm 2 and 58.8% of patients had an incisional hernia. Repairs were primarily a robotic (53.4%) or open approach (41.9%). All meshes were placed extraperitoneal. Procedure-related adverse events within 30 days occurred in 13 (8.8%) patients and included 7 (4.8%) patients with surgical site infection, 2 (1.4%) with surgical site occurrence (SSO), 4 (2.7%) requiring readmission, and 3 (2.0%) who had reoperation. The rate of SSO events requiring procedural intervention was 2.7% (4 patients) through 30 days and 3.4% (5 patients) at 12 months. The rate of procedure-related surgical site infection remained at 4.8% through 12 months (no further reports after 30 d) and 3.4% for SSO (2 reports after 30 d). There were no site-reported clinically diagnosed hernia recurrences throughout the study. Median patient follow-up including in-person visit, physical examination, reported adverse event, explant, death, and questionnaire response was 28 months (n = 148). Median patient follow-up with patient questionnaire was 36 months (n = 88).

CONCLUSIONS

Use of the PRE device, which incorporates the proven advantages of both an absorbable synthetic mesh and the long-term durability of a permanent macroporous mesh, is safe and effective in complex ventral hernia repairs. When used in the retromuscular space, the combination of these 2 materials had lower wound complications and recurrence rates than either type of material alone.

摘要

目的

分析采用GORE SYNECOR腹膜前生物材料(PRE装置)进行腹疝修补术的器械安全性和临床结局,该装置是一种采用生物可吸收网状支架技术的永久性高强度补片。

材料与方法

这项多中心回顾性研究分析了自研究入组起接受疝修补术≥1年的患者的器械/手术终点以及患者报告的结局。

结果

本分析纳入了148例患者,平均年龄56岁;66.2%符合腹疝工作组2级分类。疝的中位面积为30.0平方厘米,58.8%的患者为切口疝。修补术主要采用机器人手术(53.4%)或开放手术(41.9%)。所有补片均置于腹膜外。30天内发生的与手术相关的不良事件有13例(8.8%),包括7例(4.8%)手术部位感染、2例(1.4%)手术部位事件(SSO)、4例(2.7%)需要再次入院以及3例(2.0%)接受再次手术。需要手术干预的SSO事件发生率在30天时为2.7%(4例患者),12个月时为3.4%(5例患者)。与手术相关的手术部位感染率在12个月内一直保持在4.8%(30天后无进一步报告),SSO为3.4%(30天后2例报告)。在整个研究过程中,未出现经手术部位报告的临床诊断疝复发。患者的中位随访时间包括亲自就诊、体格检查、报告的不良事件、取出补片、死亡及问卷调查回复,为28个月(n = 148)。采用患者问卷调查的患者中位随访时间为36个月(n = 88)。

结论

PRE装置兼具可吸收合成补片的已证实优势和永久性大孔补片的长期耐用性,在复杂腹疝修补术中使用安全有效。当用于肌后间隙时,这两种材料的组合比单独使用任何一种材料具有更低的伤口并发症和复发率。

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