Fredberg Jeppe, Oma Erling, Helgstrand Frederik, Qvist Niels, Friis-Andersen Hans, Jørgensen Lars N
Digestive Disease Centre, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Surgery, Zealand University Hospital, Koege, Denmark.
Surg Endosc. 2025 May 22. doi: 10.1007/s00464-025-11792-4.
Emergency umbilical and epigastric hernia repairs (EUEHR) are common but understudied procedures. The role of different mesh positions in emergency settings is a topic of significant interest.
A retrospective nationwide Danish cohort study of patients who underwent EUEHR from 2015 to 2020. A complete follow-up was obtained on December 31, 2023, through linkage of nationwide registries and full scrutiny of medical files for those patients who underwent a reoperation. The primary outcome was operation for recurrence. Secondary outcomes were non-recurrence reoperations, early (< 90 days) reoperations, and operations for severe complications. Multivariable analyses were performed using Fine-and-Gray competing risk models.
639 patients were registered in the database, and 70.6% underwent mesh repair (open onlay: 44.1%, open sublay: 15.3%, or laparoscopic intraperitoneal (lap-IPOM): 11.1%. The median follow-up time was 4.3 years. The 5-year risk of operations for recurrence was lower after mesh use compared to suture (n = 6 (1.7%) vs. n = 8 (4.7%); p = 0.023), with a hazard ratio (HR) 0.32 (95% CI (0.11-0,92); p = 0.034). The 5-year risk of operation for other complications was similar between the suture and mesh group (n = 28 (6.2%) vs. n = 9 (4.8%); p = 0.40, HR 1.12 (0.51-2.48; p = 0.77)). Surgical site infection occurred in 1.1%, 4.3%, 2.0%, and 2.8% of suture, onlay, sublay, and Lap-IPOM repairs, respectively. Few complications were directly mesh related: onlay n = 3 (1.1%), sublay n = 2 (2.0%), and Lap-IPOM n = 1 (1.4%). Early (< 90 days) operation for other complications was more frequent after onlay than suture repair (Odds-ratio 2.95 (0.094-12.2): p = 0.066). In sub-group analysis, lap-IPOM showed a trend towards more severe complications than suture repair (HR 7.85 (0.82-75.5); p = 0.074).
Mesh repair significantly reduced operation for recurrence after EUEHR compared to suture repair with a similar risk of operation for other complications. Onlay may cause more early reoperations compared to suture repair and lap-IPOM may be associated with more severe complications.
急诊脐疝和上腹疝修补术（EUEHR）很常见，但研究较少。不同补片位置在急诊手术中的作用是一个备受关注的话题。
一项丹麦全国性的回顾性队列研究，研究对象为2015年至2020年接受EUEHR的患者。通过全国性登记系统的关联以及对接受再次手术患者的医疗档案进行全面审查，于2023年12月31日获得了完整的随访数据。主要结局是复发手术。次要结局是非复发再次手术、早期（<90天）再次手术以及严重并发症手术。使用Fine-and-Gray竞争风险模型进行多变量分析。
数据库中登记了639例患者，70.6%接受了补片修补（开放外置法：44.1%，开放腹膜前法：15.3%，或腹腔镜腹腔内补片植入术（lap-IPOM）：11.1%）。中位随访时间为4.3年。与缝合修补相比，使用补片后复发手术的5年风险较低（n = 6（1.7%）对n = 8（4.7%）；p = 0.023），风险比（HR）为0.32（95%CI（0.11 - 0.92）；p = 0.034）。缝合组和补片组其他并发症手术的5年风险相似（n = 28（6.2%）对n = 9（4.8%）；p = 0.40，HR 1.12（0.51 - 2.48；p = 0.77））。手术部位感染分别发生在缝合修补、外置法、腹膜前法和lap-IPOM修补患者中的1.1%、4.3%、2.0%和2.8%。与补片直接相关的并发症很少：外置法n = 3（1.1%），腹膜前法n = 2（2.0%），lap-IPOM n = 1（1.4%）。外置法修补后早期（<90天）因其他并发症进行的手术比缝合修补更频繁（优势比2.95（0.094 - 12.2）：p = 0.066）。在亚组分析中，lap-IPOM显示出比缝合修补有更严重并发症的趋势（HR 7.85（0.82 - 75.5）；p = 0.074）。
与缝合修补相比，补片修补在EUEHR后显著降低了复发手术的发生率，且其他并发症手术的风险相似。与缝合修补相比，外置法可能导致更多早期再次手术，而lap-IPOM可能与更严重的并发症相关。
