青少年腹股沟疝修补术后复发的再次手术：一项基于全国登记的队列研究。

Reoperation for Recurrence After Groin Hernia Repair in Adolescents: A Nationwide Register-Based Cohort Study.

作者信息

Reistrup Hugin, Fonnes Siv, Joensen Andrea, Rosenberg Jacob

机构信息

Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital-Herlev and Gentofte, Herlev, Denmark.

Section of Epidemiology, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.

出版信息

World J Surg. 2025 Jun;49(6):1441-1448. doi: 10.1002/wjs.12613. Epub 2025 May 7.

DOI:10.1002/wjs.12613

PMID:40338145

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12134194/

Abstract

BACKGROUND

Although mesh-based repairs are used in adults to reduce the risk of recurrence, their necessity in adolescents remains debated. Nonmesh repairs are often preferred in younger patients to avoid potential long-term complications, but data on recurrence rates in this age group are limited. We aimed to assess the rate of reoperation for recurrence following primary groin hernia repair in adolescents aged 10-19 years.

METHODS

This was a register-based cohort study covering three decades (1992-2022), utilizing data from the Danish National Patient Register linked to data from the Danish Civil Registration System, ensuring comprehensive nationwide coverage and complete follow-up. The cumulative rate of reoperation for recurrence was estimated at 10 years of follow-up. Cox proportional hazards regression analysis was used to compare the risk of reoperation for recurrence between mesh and nonmesh repairs. Outcomes included reoperation for recurrence, readmission, and mortality.

RESULTS

Among the 2404 included groins, most were male (80%), and the median age was 16 (IQR, 12-19) years. Most (99%) groin hernias were inguinal, and few (1%) were femoral. Of the inguinal repairs, 35% were mesh, 64% were nonmesh, and 1% were unspecified repairs. The follow-up time was median 16 (IQR, 9-21) years. The cumulative rate of reoperation for recurrence across all inguinal repairs was 3.8% (95% CI, 3.0-4.9) after 10 years of follow-up. For older adolescents aged 15-19 years, the cumulative rate of reoperation for recurrence after mesh and nonmesh repair was 2.7% (95% CI, 1.6-4.6) and 4.1% (95% CI, 2.6-6.7), respectively. Nonmesh repair had a higher adjusted hazard ratio of reoperation for recurrence compared with mesh repair (adjusted hazard ratio, 2.11; 95% CI, 1.05-4.23). For femoral repairs, most (67% [18/27]) were open nonmesh repairs, and few were reoperated for recurrence.

CONCLUSION

The cumulative rate of reoperation for recurrence was low in adolescents. These findings suggest that nonmesh repair may be sufficient for primary groin hernia repair in adolescents, potentially avoiding the need for mesh implantation.

摘要

背景

尽管基于补片的修复方法在成人中用于降低复发风险，但其在青少年中的必要性仍存在争议。在年轻患者中，非补片修复通常更受青睐，以避免潜在的长期并发症，但该年龄组复发率的数据有限。我们旨在评估10至19岁青少年原发性腹股沟疝修补术后复发再次手术的发生率。

方法

这是一项基于登记的队列研究，涵盖三十年（1992 - 2022年），利用丹麦国家患者登记处的数据，并与丹麦民事登记系统的数据相链接，确保全国范围内的全面覆盖和完整随访。在随访10年时估计复发再次手术的累积发生率。使用Cox比例风险回归分析比较补片和非补片修复术后复发再次手术的风险。结局包括复发再次手术、再次入院和死亡率。

结果

在纳入的2404例腹股沟疝中，大多数为男性（80%），中位年龄为16岁（四分位间距，12 - 19岁）。大多数（99%）腹股沟疝为腹股沟疝，少数（1%）为股疝。在腹股沟疝修补术中，35%为补片修补，64%为非补片修补，1%为未明确的修补。随访时间中位为16年（四分位间距，9 - 21年）。随访10年后，所有腹股沟疝修补术后复发再次手术的累积发生率为3.8%（95%置信区间，3.0 - 4.9）。对于15至19岁的年长青少年，补片和非补片修补术后复发再次手术的累积发生率分别为2.7%（95%置信区间，1.6 - 4.6）和4.1%（95%置信区间，2.6 - 6.7）。与补片修补相比，非补片修补术后复发再次手术的调整后风险比更高（调整后风险比，2.11；95%置信区间，1.05 - 4.23）。对于股疝修补，大多数（67%[18/27]）为开放式非补片修补，很少因复发而再次手术。