Aymen H. Sadaka , William J. O'Brien , Kamal M.F. Itani
{"title":"外科医生的判断和现有证据在腹疝修复的长期结果中的相互作用","authors":"Aymen H. Sadaka , William J. O'Brien , Kamal M.F. Itani","doi":"10.1016/j.amjsurg.2025.116292","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>Recurrence and surgical site occurrences (SSO) were directly identified via clinical and operative notes and/or imaging. Analysis was conducted via logistical regression.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>","PeriodicalId":7771,"journal":{"name":"American journal of surgery","volume":"243 ","pages":"Article 116292"},"PeriodicalIF":2.7000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"The interplay of surgeon judgment and available evidence in the long-term outcome of ventral hernia repair\",\"authors\":\"Aymen H. Sadaka , William J. O'Brien , Kamal M.F. Itani\",\"doi\":\"10.1016/j.amjsurg.2025.116292\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><div>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.</div></div><div><h3>Methods</h3><div>Recurrence and surgical site occurrences (SSO) were directly identified via clinical and operative notes and/or imaging. Analysis was conducted via logistical regression.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusion</h3><div>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.</div></div>\",\"PeriodicalId\":7771,\"journal\":{\"name\":\"American journal of surgery\",\"volume\":\"243 \",\"pages\":\"Article 116292\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S000296102500114X\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/3/7 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of surgery","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S000296102500114X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/3/7 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
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.
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.
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