Multi-institutional Experience Using Human Acellular Dermal Matrix for Ventral Hernia Repair in a Compromised Surgical Field
Multi-institutional Experience Using Human Acellular Dermal Matrix for Ventral Hernia Repair in a Compromised Surgical Field
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DOI：
10.1001/archsurg.2009.12
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发表时间：
2009-03-01
影响因子：
--
通讯作者：
Donahue, Rafe
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文献类型：
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作者：
Diaz, Jose J., Jr.;Conquest, Anne M.;Donahue, Rafe
背景：复杂腹疝修补术（CVHR）涉及到胃肠道、胆道和泌尿生殖系统手术。复杂腹疝是创伤、急诊和选择性普通外科手术中的一个重要问题，在这些手术中，假体材料是禁忌的。在这种临床情况下，原发性筋膜闭合有50%发生疝的风险。另一种选择是计划腹疝延迟修复。假设：人类脱细胞真皮基质是一个合适的植入CVHR在受损的手术领域。设计：多机构、5年回顾性研究。环境：四个学术医疗中心。患者和方法：每个中心都获得了机构审查委员会的批准。纳入本综述的患者均接受了人脱细胞真皮基质的CVHR。收集的数据包括年龄、体重指数（以体重（公斤）除以身高（米）的平方计算）、合并症、筋膜缺损大小、伤口分类、住院时间、随访时间和死亡率。主要结果为手术部位感染、瘘管复发和疝气复发。采用chi(2)和logistic回归分析。结果：240例患者符合研究标准。平均（SD）年龄为52.2岁（15.0岁），男性132例（55.0%）。最常见的合并症为高血压（115例[47.9%]），平均缺损大小为201 cm(2)。平均住院时间17.2天，平均随访317天。总死亡率为2.9%。41例疝复发率为17.1%。瘘管或造口的修复与疝复发相关（P= 0.03），与瘘管复发相关（P= 0.03）
Background: A complex ventral hernia repair (CVHR) involves a compromised surgical field where gastrointestinal, biliary, and genitourinary procedures are performed. Complex ventral hernia is a significant problem in trauma, emergency, and elective general surgery in which prosthetic material is contraindicated. In this clinical scenario, primary fascia closure carries a 50% risk of developing a hernia. The other option is a planned ventral hernia with delayed repair.Hypothesis: Human acellular dermal matrix is a suitable implant for CVHR in a compromised surgical field.Design: Multi-institutional, 5-year retrospective review.Setting: Four academic medical centers.Patients and Methods: Each center obtained institutional review board approval. Patients included in the review had undergone CVHR with human acellular dermal-matrix. Data collected included age, body mass index (calculated as weight in kilograms divided by height in meters squared), comorbidities, size of fascial defect, wound classification, hospital length of stay, length of follow-up, and mortality. Primary outcomes were surgical site infection, fistula recurrence, and hernia recurrence. Both chi(2) and logistic regression analyses were performed.Results: Two hundred forty patients met the study criteria. Their mean (SD) age was 52.2 (15.0) years, and 132 (55.0%) were men. The most common comorbidity was hypertension (115 patients [47.9%]), and the mean defect size was 201 cm(2). The mean hospital length of stay was 17.2 days, and the mean follow-up was 317 days. The overall mortality was 2.9%. The hernia recurrence rate was 17.1% (41 patients). Repair of a fistula or stoma was associated with hernia recurrence (P=.03) and with fistula recurrence (P