Predictors of mesh explantation after incisional hernia repair
Predictors of mesh explantation after incisional hernia repair
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DOI：
10.1016/j.amjsurg.2010.10.011
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发表时间：
2011-07-01
影响因子：
3
通讯作者：
Vick, Catherine C.
中科院分区：
文献类型：
--
作者：
Hawn, Mary T.;Gray, Stephen H.;Vick, Catherine C.
背景：使用人工网片进行腹股沟切开修补术可以减少腹股沟复发。网眼感染导致严重的并发症和后续腹壁重建的挑战。方法：这是一项多点队列研究，研究对象是1998年至2002年在16家退伍军人事务医院接受网状人工关节置换术的患者。结果：在1,071例网片修复者中，55例(5.1%)在永久网状假体植入后的中位时间7.3个月(四分位数范围1.4-22.2)再次植入网片。感染是最常见的外植体原因(69%)。不同的修复类型没有发现差异。调整协变量，同位同期手术(风险比[HR]=6.3)和术后手术部位感染(HR=6.5)与网片植入术相关。结论：行IHR同时行腹内手术的患者继发网片植入术的风险增加6倍以上。在这种情况下，应谨慎使用永久性假体网片。(C)2011年，由爱思唯尔公司出版。
BACKGROUND: Prosthetic mesh used for incisional hernia repair (IHR) reduces hernia recurrence. Mesh infection results in significant morbidity and challenges for subsequent abdominal wall reconstruction. The risk factors that lead to mesh explantation are not well known.METHODS: This is a multisite cohort study of patients undergoing IHR at 16 Veterans Affairs hospitals from 1998 to 2002.RESULTS: Of the 1,071 mesh repairs, 55 (5.1%) had subsequent mesh explantation at a median of 7.3 months (interquartile range 1.4-22.2) after IHR with permanent mesh prosthesis. Infection was the most common reason for explantation (69%). No differences were observed by the type of repair. Adjusting for covariates, same-site concomitant surgery (hazard ratio [HR] = 6.3) and postoperative surgical site infection (HR = 6.5) were associated with mesh explantation.CONCLUSIONS: Patients undergoing IHR with concomitant intra-abdominal procedures have a greater than 6-fold increased hazard of subsequent mesh explantation. Permanent prosthetic mesh should be used with caution in this setting. (C) 2011 Published by Elsevier Inc.