Stabilini C, Capoccia Giovannini S, Campanelli G, Cavallaro G, Bracale U, Soliani G, Pecchini F, Frascio M, Carlini F, Longo G, Rubartelli A, Camerini G
Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Policlinico San Martino Hospital, Genoa, Italy.
Gruppo Ospedaliero San Donato, University of Insubria, Milan, Italy.
Hernia. 2025 Feb 10;29(1):90. doi: 10.1007/s10029-025-03270-6.
This scoping review aimed to systematically map the existing evidence on the surgical management of complex abdominal wall hernias (CA), focusing on patient-specific factors, hernia characteristics, contamination and operative strategies to their management, in order to identify research gaps and areas for clinical improvement.
A comprehensive literature search was conducted in PubMed and Scopus, covering publications from January 2015 to June 2024. A total of 6,445 articles were identified, of which 357 met inclusion criteria (303 primary studies and 54 systematic reviews). Studies were classified into three categories: patient-related factors (P), hernia-specific features (H), and contamination (W).
Patient-related factors, particularly obesity and associated comorbidities, were consistently related to higher rates of morbidity and hernia recurrence despite prehabilitation and bariatric surgery were evaluated, results were inconclusive. Hernia-specific features, including large defect size and loss of domain, were associated with increased complication rates. Midline restoration and its achievement with component separation or preoperative botulinum toxin injections, were extensively studied, showing potential benefits. In contaminated settings, synthetic meshes outperformed biologic alternatives, demonstrating lower recurrence and morbidity rates in recent trials. Research in biosynthetic mesh is still needed.
Surgical management of CA remains a highly demanding clinical scenario with significant variability in outcomes influenced by patient factors and hernia characteristics. Techniques such as component separation and the use of synthetic meshes hold promise, but further high-quality, randomized trials are required to establish standardized protocols and optimize clinical outcomes in this challenging patient population.
本范围综述旨在系统梳理关于复杂腹壁疝（CA）手术治疗的现有证据，重点关注患者特异性因素、疝的特征、污染情况及其管理的手术策略，以识别研究空白和临床改进领域。
在PubMed和Scopus上进行了全面的文献检索，涵盖2015年1月至2024年6月的出版物。共识别出6445篇文章，其中357篇符合纳入标准（303项原发性研究和54项系统评价）。研究分为三类：患者相关因素（P）、疝特异性特征（H）和污染情况（W）。
患者相关因素，尤其是肥胖及其相关合并症，始终与较高的发病率和疝复发率相关，尽管对术前康复和减肥手术进行了评估，但结果尚无定论。疝特异性特征，包括缺损面积大及腹腔内容物无法回纳，与并发症发生率增加相关。中线修复及其通过腹壁分层分离或术前注射肉毒杆菌毒素实现的方法得到了广泛研究，显示出潜在益处。在污染情况下，合成补片优于生物补片，在近期试验中显示出较低的复发率和发病率。仍需要对生物合成补片进行研究。
CA的手术治疗仍然是一个要求很高的临床情况，结果存在很大差异，受患者因素和疝的特征影响。腹壁分层分离和使用合成补片等技术有前景，但需要进一步的高质量随机试验来建立标准化方案，并在这一具有挑战性的患者群体中优化临床结果。
