M Verdaguer-Tremolosa, V Rodrigues-Gonçalves, M P Martínez-López, J L Sánchez-García, M López-Cano
{"title":"同时进行切口疝修补术和结肠直肠手术：一步还是两步？","authors":"M Verdaguer-Tremolosa, V Rodrigues-Gonçalves, M P Martínez-López, J L Sánchez-García, M López-Cano","doi":"10.1007/s10029-024-03164-z","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>Patients requiring colorectal surgery in the context of an incisional hernia are common, but it is not clear whether the repair should be performed as a single or two-step surgery. Our aim was to evaluate complications after concomitant abdominal wall repair and colorectal surgery compared to those after incisional hernia repair alone.</p><p><strong>Methods: </strong>Adult patients who underwent elective incisional hernia surgery from 2012-2022 from the EVEREG registry were included. Patients who underwent midline incisional hernia repair as a single procedure and patients who underwent midline incisional hernia repair concomitant with colorectal surgery were included. The primary outcome was surgical site infection (SSI). The secondary outcomes were the Clavien-Dindo classification grade, in-hospital mortality and recurrence.</p><p><strong>Results: </strong>A total of 7783 patients were included: 256(3.3%) who underwent concomitant surgery and 7527(96.7%) who underwent only midline incisional hernia repair. The first group included more comorbid patients and complex hernias. SSI was found in 55.4% of patients who underwent simultaneous surgery compared to 30.7% of patients who underwent hernia repair alone (P = 0.000). Multivariate analysis revealed that the risk factors for SSI were BMI (OR = 1.07, 95% CI 1.02-1.11; P = 0.004), smoking (OR = 1.89, 95% CI 1.12-3.19; P = 0.017), transverse diameter (OR = 1.06, 95% CI 1.01-1.11; P = 0.017), component separation (OR = 1.996, 95% CI 1.25-3.08; P = 0.037) and clean-contaminated and contaminated surgeries(OR = 3.86, 95% CI 1.36-10.66; P = 0.009). Higher grades of Clavien-Dindo (P = 0.001) and mortality rates (P < 0.001) were found in the colorectal surgery group, although specific risk factors were detected. No differences were observed in terms of recurrence (P = 0.104).</p><p><strong>Conclusions: </strong>Concomitant surgery is related to greater risk of complications, especially in patients with comorbidities and complex hernias. In properly selected cases, simultaneous procedures can yield satisfactory results.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":null,"pages":null},"PeriodicalIF":2.6000,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530480/pdf/","citationCount":"0","resultStr":"{\"title\":\"Simultaneous incisional hernia repair and colorectal surgery: one or two-step procedure?\",\"authors\":\"M Verdaguer-Tremolosa, V Rodrigues-Gonçalves, M P Martínez-López, J L Sánchez-García, M López-Cano\",\"doi\":\"10.1007/s10029-024-03164-z\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>Patients requiring colorectal surgery in the context of an incisional hernia are common, but it is not clear whether the repair should be performed as a single or two-step surgery. Our aim was to evaluate complications after concomitant abdominal wall repair and colorectal surgery compared to those after incisional hernia repair alone.</p><p><strong>Methods: </strong>Adult patients who underwent elective incisional hernia surgery from 2012-2022 from the EVEREG registry were included. Patients who underwent midline incisional hernia repair as a single procedure and patients who underwent midline incisional hernia repair concomitant with colorectal surgery were included. The primary outcome was surgical site infection (SSI). The secondary outcomes were the Clavien-Dindo classification grade, in-hospital mortality and recurrence.</p><p><strong>Results: </strong>A total of 7783 patients were included: 256(3.3%) who underwent concomitant surgery and 7527(96.7%) who underwent only midline incisional hernia repair. The first group included more comorbid patients and complex hernias. SSI was found in 55.4% of patients who underwent simultaneous surgery compared to 30.7% of patients who underwent hernia repair alone (P = 0.000). Multivariate analysis revealed that the risk factors for SSI were BMI (OR = 1.07, 95% CI 1.02-1.11; P = 0.004), smoking (OR = 1.89, 95% CI 1.12-3.19; P = 0.017), transverse diameter (OR = 1.06, 95% CI 1.01-1.11; P = 0.017), component separation (OR = 1.996, 95% CI 1.25-3.08; P = 0.037) and clean-contaminated and contaminated surgeries(OR = 3.86, 95% CI 1.36-10.66; P = 0.009). Higher grades of Clavien-Dindo (P = 0.001) and mortality rates (P < 0.001) were found in the colorectal surgery group, although specific risk factors were detected. No differences were observed in terms of recurrence (P = 0.104).</p><p><strong>Conclusions: </strong>Concomitant surgery is related to greater risk of complications, especially in patients with comorbidities and complex hernias. In properly selected cases, simultaneous procedures can yield satisfactory results.</p>\",\"PeriodicalId\":13168,\"journal\":{\"name\":\"Hernia\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.6000,\"publicationDate\":\"2024-12-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11530480/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Hernia\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s10029-024-03164-z\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/9/26 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hernia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10029-024-03164-z","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/9/26 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
Simultaneous incisional hernia repair and colorectal surgery: one or two-step procedure?
Purpose: Patients requiring colorectal surgery in the context of an incisional hernia are common, but it is not clear whether the repair should be performed as a single or two-step surgery. Our aim was to evaluate complications after concomitant abdominal wall repair and colorectal surgery compared to those after incisional hernia repair alone.
Methods: Adult patients who underwent elective incisional hernia surgery from 2012-2022 from the EVEREG registry were included. Patients who underwent midline incisional hernia repair as a single procedure and patients who underwent midline incisional hernia repair concomitant with colorectal surgery were included. The primary outcome was surgical site infection (SSI). The secondary outcomes were the Clavien-Dindo classification grade, in-hospital mortality and recurrence.
Results: A total of 7783 patients were included: 256(3.3%) who underwent concomitant surgery and 7527(96.7%) who underwent only midline incisional hernia repair. The first group included more comorbid patients and complex hernias. SSI was found in 55.4% of patients who underwent simultaneous surgery compared to 30.7% of patients who underwent hernia repair alone (P = 0.000). Multivariate analysis revealed that the risk factors for SSI were BMI (OR = 1.07, 95% CI 1.02-1.11; P = 0.004), smoking (OR = 1.89, 95% CI 1.12-3.19; P = 0.017), transverse diameter (OR = 1.06, 95% CI 1.01-1.11; P = 0.017), component separation (OR = 1.996, 95% CI 1.25-3.08; P = 0.037) and clean-contaminated and contaminated surgeries(OR = 3.86, 95% CI 1.36-10.66; P = 0.009). Higher grades of Clavien-Dindo (P = 0.001) and mortality rates (P < 0.001) were found in the colorectal surgery group, although specific risk factors were detected. No differences were observed in terms of recurrence (P = 0.104).
Conclusions: Concomitant surgery is related to greater risk of complications, especially in patients with comorbidities and complex hernias. In properly selected cases, simultaneous procedures can yield satisfactory results.
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.
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