Fine Asher, Orgad Ran, Mnouskin Yuori, Solomon Daniel, Halim Nasser Abdul, Kashtan Hanoch, Schrier Ilan, Rayman Shlomi
Department of General Surgery, Assuta Ashdod Public Hospital, Affiliated with Faculty of Health and Science and Ben-Gurion University, Ashdod, Israel; Department of Surgery, Beilinson Hospital, Rabin Medical Center, Petach-Tikva, Israel; Affiliated with the School of Medicine, Tel Aviv University, Tel-Aviv, Israel.
Department of General Surgery, Assuta Ashdod Public Hospital, Affiliated with Faculty of Health and Science and Ben-Gurion University, Ashdod, Israel. Electronic address: https://twitter.com/ranorgad.
Surgery. 2025 Sep;185:109536. doi: 10.1016/j.surg.2025.109536. Epub 2025 Jul 10.
Ventral incisional hernias are a common surgical challenge, particularly when incarcerated, necessitating emergent laparotomy to prevent bowel ischemia and necrosis. The optimal approach for abdominal wall closure in these cases remains debated, with primary repair associated with greater recurrence rates and mesh reinforcement raising concerns regarding infection risks. This study aimed to compare the efficacy, safety, and recurrence rates of mesh-reinforced compared with primary closure during emergent laparotomy for incarcerated ventral incisional hernia.
A retrospective analysis was conducted on 149 patients who underwent emergent laparotomy for incarcerated ventral incisional hernia at a tertiary center from 2010 to 2020. Patients were categorized into a mesh-repair group (n = 78, 54.5%) and a primary repair group (n = 65, 45.5%). Data included demographics, laboratory values, operative details, and 30-day postoperative outcomes. Propensity score weighting was applied to balance key covariates including age, body mass index, comorbidities, preoperative laboratory values, bowel resection, wound classification, and complication severity.
Patients in the mesh-repair group were younger (61 vs 69 years old; P = .003) and had significantly lower inflammatory markers (C-reactive protein: 0.8 vs 1.5 mg/dL, P = .006). Bowel resection was more frequent in the primary repair group (31% vs 0%, P < .001). No significant differences were found in operative time (P = .14) or major complications (P = .4). Hernia recurrence was significantly lower in the mesh repair group (22% vs 44%, P = .01). After propensity score weighting, recurrence remained significantly lower with mesh (15% vs 39%; P = .002). Subgroup analysis showed no additional benefit in recurrence reduction from retro-muscular mesh placement despite increased operative time.
Mesh-reinforcement during emergent laparotomy for incarcerated ventral incisional hernia is associated with a significantly lower rate of hernia recurrence compared with primary closure. Mesh-reinforced repair demonstrated comparable postoperative morbidity, including rates of major complications, when carefully selected patients were treated. Although this study provides valuable insights into emergent ventral incisional hernia repair strategies, the high recurrence rate in the mesh group raises questions regarding the long-term efficacy of mesh reinforcement in emergent settings.
腹直肌切口疝是常见的外科挑战，尤其是发生嵌顿时，需要紧急剖腹手术以防止肠缺血和坏死。这些病例中腹壁闭合的最佳方法仍存在争议，一期修复复发率较高，而使用补片加强则引发对感染风险的担忧。本研究旨在比较嵌顿性腹直肌切口疝急诊剖腹手术中补片加强与一期缝合的疗效、安全性及复发率。
对2010年至2020年在一家三级中心接受嵌顿性腹直肌切口疝急诊剖腹手术的149例患者进行回顾性分析。患者分为补片修复组（n = 78，54.5%）和一期修复组（n = 65，45.5%）。数据包括人口统计学资料、实验室检查值、手术细节及术后30天的结果。应用倾向评分加权法平衡关键协变量，包括年龄、体重指数、合并症、术前实验室检查值、肠切除情况、伤口分类及并发症严重程度。
补片修复组患者更年轻（61岁对69岁；P = 0.003），炎症指标显著更低（C反应蛋白：0.8对1.5mg/dL，P = 0.006）。一期修复组肠切除更常见（31%对0%，P < 0.001）。手术时间（P = 0.14）或主要并发症（P = 0.4）无显著差异。补片修复组疝复发率显著更低（22%对44%，P = 0.01）。倾向评分加权后，补片修复的复发率仍显著更低（15%对39%；P = 0.002）。亚组分析显示，尽管手术时间增加，但肌后补片放置在降低复发率方面无额外益处。
嵌顿性腹直肌切口疝急诊剖腹手术中使用补片加强与一期缝合相比，疝复发率显著更低。在精心挑选患者进行治疗时，补片加强修复的术后发病率相当，包括主要并发症发生率。尽管本研究为急诊腹直肌切口疝修复策略提供了有价值的见解，但补片组的高复发率引发了关于急诊情况下补片加强长期疗效的疑问。
