PDF(Pubmed)
Abstract：
OBJECTIVE: Heavyweight polypropylene (HWPP) mesh is thought to increase inflammatory response and delay tissue integration compared to mediumweight (MWPP). Reactive fluid volume (i.e., drain output) may be a reasonable surrogate for integration. We hypothesized that daily drain output is higher with HWPP compared to MWPP in open retromuscular ventral hernia repair (VHR).
METHODS: This is a post-hoc analysis of a multicenter, randomized clinical trial conducted March 2017-April 2019 comparing MWPP and HWPP for VHR. Retromuscular drain output in milliliters was measured at 24-h intervals up to postoperative day seven. Univariate analyses compared differences in daily drain output and time to drain removal. Multivariable analyses compared total drain output and wound morbidity within 30 days and hernia recurrence at 1 year.
RESULTS: 288 patients were included; 140 (48.6%) HWPP and 148 (51.4%) MWPP. Daily drain output for days 1-3 was higher for HWPP vs. MWPP (total volume: 837.8 mL vs. 656.5 mL) (p < 0.001), but similar on days 4-7 (p > 0.05). Median drain removal time was 5 days for both groups. Total drain output was not predictive of 30-day wound morbidity (p > 0.05) or hernia recurrence at 1 year (OR 1, p = 0.29).
CONCLUSIONS: While HWPP mesh initially had higher drain outputs, it rapidly returned to levels similar to MWPP by postoperative day three and there was no difference in clinical outcomes. We believe that drains placed around HWPP mesh can be managed similarly to MWPP mesh.
METHODS: This is a post-hoc analysis of a multicenter, randomized clinical trial conducted March 2017-April 2019 comparing MWPP and HWPP for VHR. Retromuscular drain output in milliliters was measured at 24-h intervals up to postoperative day seven. Univariate analyses compared differences in daily drain output and time to drain removal. Multivariable analyses compared total drain output and wound morbidity within 30 days and hernia recurrence at 1 year.
RESULTS: 288 patients were included; 140 (48.6%) HWPP and 148 (51.4%) MWPP. Daily drain output for days 1-3 was higher for HWPP vs. MWPP (total volume: 837.8 mL vs. 656.5 mL) (p < 0.001), but similar on days 4-7 (p > 0.05). Median drain removal time was 5 days for both groups. Total drain output was not predictive of 30-day wound morbidity (p > 0.05) or hernia recurrence at 1 year (OR 1, p = 0.29).
CONCLUSIONS: While HWPP mesh initially had higher drain outputs, it rapidly returned to levels similar to MWPP by postoperative day three and there was no difference in clinical outcomes. We believe that drains placed around HWPP mesh can be managed similarly to MWPP mesh.
摘要：
目的：与中等体重（MWPP）相比，重重量聚丙烯（HWPP）网被认为增加了炎症反应并延迟了组织整合。活性流体体积(即，漏极输出)可能是集成的合理替代。我们假设在开放式肌后腹疝修补术（VHR）中，HWPP的每日引流量高于MWPP。
方法：这是对多中心的事后分析，2017年3月至2019年4月进行的随机临床试验，比较MWPP和HWPP对VHR的影响。直到术后第7天，每隔24小时测量一次以毫升为单位的肌后引流输出。单变量分析比较了每日排水输出和排水去除时间的差异。多变量分析比较了30天内的总引流量和伤口发病率以及1年时的疝气复发。
结果：288例患者纳入研究；140例（48.6%）HWPP和148例（51.4%）MWPP。HWPP的1-3天的每日排水输出较高，而不是MWPP（总体积：837.8mL与656.5mL）（p<0.001），但在第4-7天相似（p>0.05）。两组的平均引流时间为5天。总引流输出不能预测30天的伤口发病率（p>0.05）或1年时的疝气复发（OR1，p=0.29）。
结论：虽然HWPP网格最初具有较高的漏极输出，术后第3天,其迅速恢复至与MWPP相似的水平,且临床结局无差异.我们认为，HWPP网周围的排水沟可以类似于MWPP网进行管理。
方法：这是对多中心的事后分析，2017年3月至2019年4月进行的随机临床试验，比较MWPP和HWPP对VHR的影响。直到术后第7天，每隔24小时测量一次以毫升为单位的肌后引流输出。单变量分析比较了每日排水输出和排水去除时间的差异。多变量分析比较了30天内的总引流量和伤口发病率以及1年时的疝气复发。
结果：288例患者纳入研究；140例（48.6%）HWPP和148例（51.4%）MWPP。HWPP的1-3天的每日排水输出较高，而不是MWPP（总体积：837.8mL与656.5mL）（p<0.001），但在第4-7天相似（p>0.05）。两组的平均引流时间为5天。总引流输出不能预测30天的伤口发病率（p>0.05）或1年时的疝气复发（OR1，p=0.29）。
结论：虽然HWPP网格最初具有较高的漏极输出，术后第3天,其迅速恢复至与MWPP相似的水平,且临床结局无差异.我们认为，HWPP网周围的排水沟可以类似于MWPP网进行管理。
