Messer Nir, Bertke Alex, Miller Benjamin T, Beffa Lucas R A, Petro Clayton C, Krpata David M, Lahat Guy, Nizri Eran, Abu-Abeid Adam, Kanani Fahim, Lessing Yonatan, McMichael John, Rosen Michael J, Prabhu Ajita S
Department of General Surgery, Cleveland Clinic Center for Abdominal Core Health, Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Surgery, Tel Aviv Sourasky Medical Center and Faculty of Medicine, Tel -Aviv University, Tel Aviv, Israel.
Hernia. 2025 May 2;29(1):153. doi: 10.1007/s10029-025-03346-3.
Complete primary fascial closure following midline laparotomy is occasionally unachievable, necessitating abdominal wall closure via fascial bridging with polyglactin 910 (Vicryl) mesh. Despite its frequent use, literature on the outcomes of Vicryl mesh for fascial bridging remains sparse and controversial, with some studies indicating potential associations with enterocutaneous fistulas and bowel obstruction. This study evaluates the outcomes of fascial bridging utilizing Vicryl mesh for non-trauma laparotomies.
We conducted a retrospective analysis of adult patients who underwent abdominal wall closure using Vicryl mesh at Cleveland Clinic centers from January 2018 to April 2023. Data were extracted from the Epic System, focusing on outcomes including fistula formation, the need for interventions for small bowel obstruction, and overall wound and postoperative morbidity, with a minimum follow-up of six months.
Among the 124,536 patients who underwent non-trauma laparotomies, 202 (0.17%) met the inclusion criteria, with a median follow-up of 47 months (SD ± 18.9 months). Postoperative outcomes following abdominal wall closure with Vicryl mesh included a 48.5% rate of surgical site infections, a 27.2% incidence of skin dehiscence, a 9.9% occurrence of soft tissue necrosis, and 2% experienced bowel evisceration secondary to mesh detachment. Enterocutaneous fistulas developed in 8.4% of patients, with no interventions for small bowel obstruction required within the first six months postoperatively. These complication rates are comparable to other abdominal closure techniques in similarly complex cases.
Fascial bridging with Vicryl mesh is a safe method for abdominal wall closure, with enterocutaneous fistula and small bowel obstruction rates comparable to those seen with other techniques. Nevertheless, primary closure of the linea alba should be prioritized, with mesh implantation minimized whenever feasible.
经腹正中切口剖腹手术后，有时无法实现完全的原发性筋膜闭合，因此需要使用聚乙醇酸910（薇乔）网片进行筋膜桥接来关闭腹壁。尽管其使用频繁，但关于薇乔网片用于筋膜桥接的结果的文献仍然稀少且存在争议，一些研究表明其与肠皮肤瘘和肠梗阻可能存在关联。本研究评估了使用薇乔网片进行筋膜桥接在非创伤性剖腹手术中的结果。
我们对2018年1月至2023年4月在克利夫兰诊所中心接受使用薇乔网片进行腹壁闭合的成年患者进行了回顾性分析。数据从Epic系统中提取，重点关注包括瘘管形成、小肠梗阻干预需求以及总体伤口和术后发病率等结果，最短随访时间为6个月。
在124,536例接受非创伤性剖腹手术的患者中，202例（0.17%）符合纳入标准，中位随访时间为47个月（标准差±18.9个月）。使用薇乔网片进行腹壁闭合后的术后结果包括手术部位感染率为48.5%，皮肤裂开发生率为27.2%，软组织坏死发生率为9.9%，2%的患者因网片脱离继发肠外露。8.4%的患者发生了肠皮肤瘘，术后前6个月内无需对小肠梗阻进行干预。这些并发症发生率与类似复杂病例中的其他腹壁闭合技术相当。
使用薇乔网片进行筋膜桥接是一种安全的腹壁闭合方法，肠皮肤瘘和小肠梗阻发生率与其他技术相当。尽管如此，应优先考虑白线的原发性闭合，只要可行，应尽量减少网片植入。
