Delayed vs single-staged abdominal wall reconstruction in contaminated ventral hernia.

IF 2.6 2区医学 Q1 SURGERY

Hernia Pub Date : 2024-11-16 DOI:10.1007/s10029-024-03195-6

Sara M Maskal, Raha Al Marzooqi, Ouen Mali, Li-Ching Huang, Ryan C Ellis, Kimberly Woo, Daphne Remulla, Benjamin T Miller, Lucas R A Beffa, Clayton C Petro, Ajita S Prabhu, Michael J Rosen

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引用次数: 0

Abstract

Introduction: When faced with contaminated ventral hernia repairs, surgeons must decide to repair the defect in a single-stage or delay the definitive repair until a clean scenario has been achieved. We sought to compare wound complications, long-term hernia recurrence and quality of life for patients who underwent delayed versus single-staged abdominal wall reconstruction (AWR) in the setting of clean-contaminated and contaminated wounds.

Methods: The Abdominal Core Health Quality Collaborative was used to identify adult patients at our institution who underwent open AWR with retromuscular synthetic mesh placement between January 2014 and August 2023. The delayed group included patients who underwent clean-contaminated or contaminated abdominal operation in the setting of a ventral hernia without placement of permanent synthetic mesh, then underwent AWR with permanent synthetic mesh placement in a separate operation. The single-staged group had clean-contaminated or contaminated wounds concomitant with AWR. Outcomes of the AWR were compared.

Results: 63 patients underwent a delayed AWR and 375 patients underwent a single-staged AWR with a median(IQR) follow-up of 3(2,5)years. Most common concomitant procedures involved small intestine(30%) or hepatobiliary(30%). Most common index operations in delayed AWR were ileostomy(52.4%) and colostomy(14.2%) reversals. Median(IQR) time between initial operation and definitive AWR was 1.0 (0.7, 1.9)years. Median(IQR) hernia width was 11.35(8.4, 15.0)cm at initial operation and 16.0(15.0,20.0)cm at AWR for the delayed group(p < 0.001). Three patients (19%) in the delayed group and 14(12%) in the single-staged underwent wound debridement within 30-days(p = 0.46); a single patient in each required partial mesh excision within 30-days(p = 0.098). Wound morbidity, reoperation and hernia recurrence were similar (p > 0.05).

Conclusion: In patients with a ventral hernia and separate indication for abdominal operation with a clean-contaminated or contaminated wound, either delayed or single-stage approaches to AWR may be viable.

查看原文本刊更多论文

污染性腹股沟疝的延迟腹壁重建与单阶段腹壁重建。

简介：面对受污染的腹股沟疝修补术，外科医生必须决定是单阶段修补缺损，还是推迟最终修补，直到达到清洁的情况。我们试图比较在清洁污染和污染伤口的情况下，接受延迟腹壁重建（AWR）和单阶段腹壁重建（AWR）的患者的伤口并发症、长期疝复发率和生活质量：我们利用腹部核心健康质量协作组织（Abdominal Core Health Quality Collaborative）来识别本院在 2014 年 1 月至 2023 年 8 月期间接受开放式腹壁重建术（AWR）并置入再肌层合成网片的成年患者。延迟组包括在腹股沟疝未放置永久性合成网片的情况下接受了清洁污染或污染腹部手术，然后在单独手术中接受了放置永久性合成网片的 AWR 的患者。单阶段组在进行腹腔疝切除术的同时进行了清洁或污染伤口手术。对 AWR 的结果进行了比较：63名患者接受了延迟AWR，375名患者接受了单阶段AWR，随访中位数（IQR）为3（2,5）年。最常见的并发症涉及小肠（30%）或肝胆（30%）。延迟AWR中最常见的指标手术是回肠造口术（52.4%）和结肠造口术（14.2%）逆转。从初次手术到最终AWR的中位（IQR）时间为1.0（0.7，1.9）年。初次手术时疝气宽度的中位数（IQR）为 11.35（8.4, 15.0）厘米，延迟手术组的疝气宽度为 16.0（15.0, 20.0）厘米（P 0.05）：结论：对于腹股沟疝患者和腹部手术的单独适应症，以及伤口被清洁污染或污染的患者，延迟或单段 AWR 方法都是可行的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.