瘘管性与非瘘管性克罗恩病患者行切口疝修补术后发生网片相关并发症和复发的情况。

Mesh-related complications and recurrence after incisional hernia repair in patients with fistulizing versus non-fistulizing Crohn's disease.

机构信息

Centre for Surgical Science, Zealand University Hospital, University of Copenhagen, Lykkebækvej 1, 4600, Køge, Denmark.

Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.

出版信息

Hernia. 2024 Nov 29;29(1):36. doi: 10.1007/s10029-024-03228-0.

DOI:10.1007/s10029-024-03228-0

PMID:39611992

Abstract

PURPOSE

Patients with Crohn's disease (CD) frequently undergo multiple abdominal operations, which increase the risk of incisional hernia repair (IHR) and associated mesh-related complications. Patients with intra-abdominal fistulizing CD (FCD) may be more susceptible to mesh-related complications than patients with non-fistulizing CD (non-FCD). The primary objective was to evaluate the risk of reoperation due to mesh-related complications after IHR in patients with FCD and non-FCD. Secondarily, the study evaluated the impact of isolated perianal fistulizing CD on mesh-related complications and the difference in hernia recurrence reoperation rates between FCD and non-FCD patients.

METHODS

This nationwide study followed patients from 30 days after their first recorded IHR until reoperation due to mesh-related complications or hernia recurrence. Cumulative incidence proportion and Cox regression analysis were used to estimate the risk of these outcomes.

RESULTS

A total of 334 patients with CD (FCD, n = 55; non-FCD, n = 279) underwent IHR between 2007 and 2016 with a follow-up rate of 100%. FCD patients had a significantly higher 5 year risk of reoperation for mesh-related complications (HR 15.95, 95% CI 4.29-59.35) compared with non-FCD patients. None of the patients with isolated perianal fistulizing disease required a reoperation for mesh-related complications. The overall risk of reoperation for recurrence was 8.7%, and did not vary significantly between FCD and non-FCD patients (HR 1.06, 95% CI 0.44-2.58).

CONCLUSIONS

FCD may be associated with higher rates of mesh-related complications compared with non-FCD, although larger studies are needed to confirm this finding. Conversely, isolated perianal fistulas do not appear to be associated with an increased risk of mesh-related complications. The benefits associated with mesh should be balanced with the risk of long-term mesh-related complications in patients with FCD.

摘要

目的

患有克罗恩病（CD）的患者经常需要进行多次腹部手术，这增加了切口疝修补术（IHR）和相关网片相关并发症的风险。与非瘘管性 CD（non-FCD）患者相比，有腹腔内瘘管性 CD（FCD）的患者可能更容易发生网片相关并发症。主要目的是评估 FCD 和 non-FCD 患者在 IHR 后因网片相关并发症而再次手术的风险。其次，本研究评估了孤立性肛周瘘管性 CD 对网片相关并发症的影响以及 FCD 和 non-FCD 患者疝复发再手术率的差异。

方法

本项全国性研究从患者首次记录的 IHR 后 30 天开始，直到因网片相关并发症或疝复发而再次手术。使用累积发生率比例和 Cox 回归分析来估计这些结局的风险。

结果

2007 年至 2016 年间，共有 334 例 CD 患者（FCD 患者 n=55；non-FCD 患者 n=279）接受了 IHR，随访率为 100%。与 non-FCD 患者相比，FCD 患者 5 年内因网片相关并发症而再次手术的风险显著更高（HR 15.95，95%CI 4.29-59.35）。没有任何孤立性肛周瘘管性疾病患者需要因网片相关并发症而再次手术。总体复发再手术风险为 8.7%，且在 FCD 和 non-FCD 患者之间无显著差异（HR 1.06，95%CI 0.44-2.58）。