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IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-03-07 DOI:10.1016/j.amjsurg.2025.116292

Aymen H. Sadaka , William J. O'Brien , Kamal M.F. Itani

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引用次数: 0

摘要

背景自 2011 年以来，新英格兰退伍军人疝注册中心（NEVAHR）从 5 个退伍军人医疗中心前瞻性地收集了腹股沟疝修补术（VHR）的手术细节。本研究旨在确定与复发相关的因素。方法通过临床和手术记录和/或影像学检查直接确定复发和手术部位发生率（SSO）。结果共有 681 例 VHR。589例（86.5%）修复术中使用了网片，网片与较大的平均缺损尺寸（p < 0.001）和切口疝（p = 0.007）有关。网片修复术中有 117 例（19.9%）复发，缝合修复术中有 22 例（23.9%）复发（p = 0.033）。在网片修复术中，复发与较高的体重指数（p = 0.009）、吸烟（p = 0.012）、腹膜旁和肋下疝（p = 0.003; p = 0.042）、SSO（p = 0.009）、腹腔镜（p = 0.042）和较小的网片-筋膜重叠（p = 0.039）有关。结论尽管 NEVAHR 外科医生做出了正确的决策，但缝合修补术对 2 厘米疝气的效果不佳。对于 2 厘米的疝气，缝合修补术的实用性有待进一步研究。

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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The interplay of surgeon judgment and available evidence in the long-term outcome of ventral hernia repair

Background

Since 2011, the New England VA Hernia Registry (NEVAHR) prospectively collected operative details of ventral hernia repairs (VHRs) from 5 VA medical centers. This study aims to determine factors associated with recurrence.

Methods

Recurrence and surgical site occurrences (SSO) were directly identified via clinical and operative notes and/or imaging. Analysis was conducted via logistical regression.

Results

There were 681 VHRs. Mesh was used in 589 (86.5 %) repairs and was associated with larger average defect sizes (p < 0.001) and incisional hernias (p = 0.007). There were 117 (19.9 %) recurrences among mesh repairs and 22 (23.9 %) among suture repairs (p = 0.033). Among mesh repairs, recurrence was associated with higher BMI (p = 0.009), smoking (p = 0.012), parastomal and subcostal hernias (p = 0.003; p = 0.042), SSOs (p = 0.009), laparoscopy (p = 0.042), and smaller mesh-fascia overlap (p = 0.039). No factors associated with recurrence among suture repairs.

Conclusion

Despite proper decision-making by NEVAHR surgeons, suture repair underperforms for hernias >2 cm. Utility of suture repair for defects <2 cm requires more investigation.

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.