Levy Jacob, Wagner Benjamin D, Shammas Ronnie L, Boe Lillian A, Ariyan Charlotte E, Brady Mary S, Allen Robert J, Matros Evan, Mehrara Babak J, Nelson Jonas A
Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Hernia. 2025 Sep 17;29(1):274. doi: 10.1007/s10029-025-03468-8.
Hernia repair following cancer surgery is often challenging due to prior radiation therapy, malnutrition, and immunosuppression. Poly-4-hydroxybutyrate (P4HB) is a biosynthetic mesh that balances strength and biocompatibility, potentially optimizing outcomes in this high-risk population. This study aimed to evaluate recurrence and surgical site complications associated with P4HB mesh in oncologic patients undergoing incisional hernia repair and to identify surgical techniques related to improved outcomes.
Patients with previous oncologic abdominal or pelvic surgery who developed an incisional hernia and underwent surgical repair using P4HB from January 2018 to December 2023 were identified. Patients were analyzed according to wound classification. Primary outcomes included hernia recurrence and surgical site complications (hematoma, infection/cellulitis, superficial wound dehiscence, and abscess formation).
102 patients [median (IQR) age 63 (55-69) years; median BMI 26 (23-30) kg/m] were included, with a median follow-up of 26.1 (15.1-40.1) months. The overall recurrence rate was 8.8%, significantly differing between clean (Class I) and contaminated (Class II-IV) cases (0% vs. 17%, p = 0.003). Surgical complications occurred in 24% of patients, with seroma (8.8%) and superficial wound dehiscence (7.8%) being the most common, and complication rates comparable between wound classifications. Bilateral external oblique release (HR, 0.16; 95% CI, 0.04-0.65; p = 0.01) and retrorectus mesh placement (HR, 0.05; 95% CI, 0.01-0.36; p = 0.004) were independently associated with reduced recurrence.
P4HB mesh in incisional hernia repair for oncologic patients yields low recurrence rates and acceptable complication rates. Bilateral external oblique release and retrorectus mesh placement are surgical techniques significantly associated with improved outcomes.
由于先前的放射治疗、营养不良和免疫抑制，癌症手术后的疝修补术往往具有挑战性。聚-4-羟基丁酸酯（P4HB）是一种生物合成补片，可平衡强度和生物相容性，有可能优化这一高危人群的治疗效果。本研究旨在评估接受切口疝修补术的肿瘤患者中与P4HB补片相关的复发情况和手术部位并发症，并确定与改善治疗效果相关的手术技术。
确定2018年1月至2023年12月期间因先前的腹部或盆腔肿瘤手术而发生切口疝并使用P4HB进行手术修补的患者。根据伤口分类对患者进行分析。主要结局包括疝复发和手术部位并发症（血肿、感染/蜂窝织炎、浅表伤口裂开和脓肿形成）。
纳入102例患者[年龄中位数（IQR）为63（55-69）岁；BMI中位数为26（23-30）kg/m²]，中位随访时间为26.1（15.1-40.1）个月。总体复发率为8.8%，清洁（I类）和污染（II-IV类）病例之间有显著差异（0%对17%，p = 0.003）。24%的患者发生手术并发症，其中血清肿（8.8%）和浅表伤口裂开（7.8%）最为常见，不同伤口分类的并发症发生率相当。双侧腹外斜肌松解术（HR，0.16；95%CI，0.04-0.65；p = 0.01）和腹直肌后补片放置（HR，0.05；95%CI，0.01-0.36；p = 0.004）与复发率降低独立相关。
P4HB补片用于肿瘤患者的切口疝修补术复发率低，并发症发生率可接受。双侧腹外斜肌松解术和腹直肌后补片放置是与改善治疗效果显著相关的手术技术。
