炎症性肠病患者择期腹股沟疝补片修补术后的长期结局

Long-term outcomes after elective inguinal hernia mesh-repair in patients with inflammatory bowel disease.

作者信息

Lovén Hans, Erichsen Rune, Tøttrup Anders, Bisgaard Thue

机构信息

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

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

出版信息

Hernia. 2025 May 23;29(1):183. doi: 10.1007/s10029-025-03362-3.

DOI:10.1007/s10029-025-03362-3

PMID:40407929

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12102129/

Abstract

BACKGROUND

Knowledge of long-term outcomes following elective inguinal hernia mesh-repair in patients with inflammatory bowel disease (IBD) remains limited. Pathophysiological differences between Crohn's disease (CD) and ulcerative colitis (UC) may influence mesh-related complications and recurrence risk. The primary objective was to assess the reoperation risk for mesh-related complications, and secondarily, recurrence after inguinal hernia mesh-repair in patients with CD and UC. The impact of fistulising disease (intra-abdominal/perianal) and surgical technique (open/laparoscopic) on both outcomes was also analysed based on the available data.

METHODS

This nationwide cohort study (2007-2016) followed IBD patients undergoing elective inguinal hernia mesh-repair to assess risks of reoperation for mesh-related complications or recurrence. Risks were estimated using cumulative incidence and Cox regression analyses.

RESULTS

Among 1,072 patients with IBD (CD = 264, UC = 698, IBD-unclassified = 110), the five-year reoperation risk was 0.5% for mesh-related complications and 5.7% for recurrence. Fistulising disease was present in 6.9% (n = 74) of all patients with IBD: perianal in 95% (n = 70) and intra-abdominal in 5% (n = 4). There were too few mesh-related complications (n = 5) to support statistical analysis of this outcome. Recurrence risk was not significantly affected by IBD subtype: CD (reference), UC (HR = 1.67, 95% CI: 0.77-3.64), IBD-U (HR = 0.91, 95% CI: 0.24-3.44), or surgical technique: transabdominal preperitoneal (TAPP) (reference), and Lichtenstein (HR = 0.80, 95% CI: 0.43-1.47).

CONCLUSION

This study suggests that inguinal hernia mesh-repair is also safe among IBD patients regardless of subtype, surgical technique, or perianal fistulation. Similarly, recurrence risk was unaffected by these factors. Limited data prevented conclusions on intra-abdominal fistulising disease as a potential risk-factor for poor surgical outcomes.

摘要

背景

炎症性肠病（IBD）患者择期腹股沟疝修补术后的长期预后相关知识仍然有限。克罗恩病（CD）和溃疡性结肠炎（UC）之间的病理生理差异可能会影响与补片相关的并发症及复发风险。主要目的是评估IBD患者腹股沟疝补片修补术后与补片相关并发症的再次手术风险，其次是评估复发风险。还根据现有数据分析了瘘管病（腹内/肛周）和手术技术（开放/腹腔镜）对这两种结局的影响。

方法

这项全国性队列研究（2007 - 2016年）对接受择期腹股沟疝补片修补术的IBD患者进行随访，以评估与补片相关并发症或复发的再次手术风险。风险通过累积发病率和Cox回归分析进行估计。

结果

在1072例IBD患者中（CD = 264例，UC = 698例，未分类IBD = 110例），与补片相关并发症的五年再次手术风险为0.5%，复发风险为5.7%。所有IBD患者中有6.9%（n = 74）存在瘘管病：95%（n = 70）为肛周瘘管病，5%（n = 4）为腹内瘘管病。与补片相关的并发症数量太少（n = 5），无法支持对该结局进行统计分析。复发风险未受到IBD亚型（CD（参照）、UC（HR = 1.67，95%CI：0.77 - 3.64）、未分类IBD（HR = 0.91，95%CI：0.24 - 3.44））或手术技术（经腹腹膜前修补术（TAPP）（参照）、Lichtenstein修补术（HR = 0.80，95%CI：0.43 - 1.47））的显著影响。