Preperitoneal Ventral Hernia Repair A Decade Long Prospective Observational Study With Analysis of 1023 Patient Outcomes

被引:64
作者
Heniford, B. Todd [1 ]
Ross, Samuel W. [1 ]
Wormer, Blair A. [1 ]
Walters, Amanda L. [1 ]
Lincourt, Amy E. [1 ]
Colavita, Paul D. [1 ]
Kercher, Kent W. [1 ]
Augenstein, Vedra A. [1 ]
机构
[1] Carolinas Med Ctr, Carolinas Hernia Ctr, Div Gastrointestinal & Minimally Invas Surg, Charlotte, NC 28203 USA
关键词
abdominal wall reconstruction; biologic mesh; hernia; hernia recurrence; lightweight mesh; mesh; mesh infection; preperitoneal; ventral hernia repair; wound complications; COMPONENT SEPARATION TECHNIQUE; QUALITY-OF-LIFE; MESH REPAIR; INCISIONAL HERNIA; LAPAROSCOPIC REPAIR; SEROMA FORMATION; SUTURE REPAIR; PANNICULECTOMY; TRIAL; COMPLICATIONS;
D O I
10.1097/SLA.0000000000002966
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objectives: The aim of this study was to examine the outcomes of over a decade's experience utilizing preperitoneal ventral hernia repair (PP-VHR). Background: PP-VHR was first described by our group in 2006, and there have been no subsequent reports of outcomes with this technique. Methods: A prospective study of all PP-VHR from January, 2004 to April, 2016 was performed. Multivariate stepwise logistic regression and Cox proportional-hazard models were used to identify predictors of wound complications and hernia recurrence, respectively. Results: There were 1023 PP-VHRs. Mean age was 57.2 +/- 12.6 years, BMI 33.7 +/- 11.4 kg/m(2), defect size 210.0 +/- 221.4 cm(2); 23.7% had diabetes, 13.9% were smokers, 68.7% were recurrent, and 23.6% incarcerated. Component separation was required in 43.6%, and a panniculectomy was performed in 30.0%. Wound complication was present in 27.3% of patients, with 1.7% having a mesh infection. In all, there were 53 (5.2%) hernia recurrences and 36 (3.9%) in the synthetic repairs, with a mean follow-up of 27.0 +/- 26.4 months. On multivariate regression (odds ratio or hazard ratio, 95% confidence interval), diabetes (1.9, 1.4-3.0), panniculectomy (2.6, 1.8-3.9), and operations requiring biologic mesh were predictors of wound complications, whereas recurrent hernia repair (2.69, 1.14-6.35), biologic mesh (3.1, 1.67-5.75), and wound complications (3.01, 1.69-5.39) were predictors of hernia recurrence. Conclusions: An open PP-VHR is a very effective means to repair large, complex, and recurrent hernias resulting in a low recurrence rate. Mesh choice in VHR is important and was associated with hernia recurrence and wound complications in this population.
引用
收藏
页码:364 / 374
页数:11
相关论文
共 49 条
  • [1] ALBRIGHT E, 2011, AM SURGEON, V0077, P00839
  • [2] Alexandre JH., 2007, HERNIA, V11, P293
  • [3] Augenstein VA, 2016, TREATMENT 161 CONSEC
  • [4] BERGER RL, 2013, J AM COLL SURGEONS, V0217, P00974, DOI DOI 10.1016/J.JAMCOLLSURG.2013.08.003
  • [5] BREUING K, 2010, SURGERY, V0148, P00544, DOI DOI 10.1016/J.SURG.2010.01.008
  • [6] BURGER JW, 2004, ANN SURG, V0240, P00578
  • [7] CARBONELL AM, 2013, J AM COLL SURGEONS, V0217, P00991, DOI DOI 10.1016/J.JAMCOLLSURG.2013.07.382
  • [8] Cavallo BK, 2013, AM COLL SURG ANN CLI
  • [9] CHOI JJ, 2012, ANN SURG, V0255, P00176, DOI DOI 10.1097/SLA.0B013E31822518E6
  • [10] COBB WS, 2005, J SURG RES, V0129, P00231, DOI DOI 10.1016/J.JSS.2005.06.015