Simultaneous incisional hernia repair and colorectal surgery: one or two-step procedure?

IF 2.6 2区医学 Q1 SURGERY Hernia Pub Date : 2024-12-01 Epub Date: 2024-09-26 DOI:10.1007/s10029-024-03164-z

M Verdaguer-Tremolosa, V Rodrigues-Gonçalves, M P Martínez-López, J L Sánchez-García, M López-Cano

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Abstract

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.

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同时进行切口疝修补术和结肠直肠手术：一步还是两步？

目的：需要在切口疝的情况下进行结直肠手术的患者很常见，但目前尚不清楚修补术应作为单步手术还是两步手术进行。我们的目的是评估同时进行腹壁修补术和结肠直肠手术后的并发症与单独进行切口疝修补术后的并发症的比较：方法：纳入2012-2022年期间在EVEREG登记处接受择期切口疝手术的成人患者。方法：纳入2012-2022年期间在EVEREG登记处接受择期切口疝手术的成人患者，包括单独接受中线切口疝修补术的患者和同时接受中线切口疝修补术和结直肠手术的患者。主要结果是手术部位感染（SSI）。次要结果为 Clavien-Dindo 分级、院内死亡率和复发率：结果：共纳入 7 783 例患者：结果：共纳入 7783 例患者：256 例（3.3%）接受了同期手术，7527 例（96.7%）仅接受了中线切口疝修补术。第一组包括更多合并症患者和复杂的疝气。在同时接受手术的患者中，55.4% 发现了 SSI，而在仅接受疝修补术的患者中，SSI 仅占 30.7%（P = 0.000）。多变量分析显示，SSI 的风险因素包括体重指数（OR = 1.07，95% CI 1.02-1.11；P = 0.004）、吸烟（OR = 1.89，95% CI 1.12-3.19；P = 0.017）、横向直径（OR = 1.06，95% CI 1.01-1.11；P = 0.017）、组件分离（OR = 1.996，95% CI 1.25-3.08；P = 0.037）以及清洁污染和污染手术（OR = 3.86，95% CI 1.36-10.66；P = 0.009）。Clavien-Dindo 等级越高（P = 0.001），死亡率越高（P 结论：同时手术与并发症风险增加有关，尤其是合并症患者和复杂疝气患者。在经过适当选择的病例中，同时进行手术可获得满意的效果。

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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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

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.