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Abstract：
BACKGROUND: Abdominal wall deficiencies or weakness are a common complication of temporary ostomies, and incisional hernias frequently develop after colostomy or ileostomy takedown. The use of synthetic meshes to reinforce the abdominal wall has reduced hernia occurrence. Biologic meshes have also been used to enhance healing, particularly in contaminated conditions. Reinforced tissue matrices (RTMs), which include a biologic scaffold of native extracellular matrix and a synthetic component for added strength/durability, are designed to take advantage of aspects of both synthetic and biologic materials. To date, RTMs have not been reported to reinforce the abdominal wall following stoma reversal.
OBJECTIVE: To evaluate the effectiveness of using an RTM to reinforce the abdominal wall at stoma takedown sites.
METHODS: Twenty-eight patients were selected with a parastomal and/or incisional hernia who had received a temporary ileostomy or colostomy for fecal diversion after rectal cancer treatment or trauma. Following hernia repair and proximal stoma closure, RTM (OviTex® 1S permanent or OviTex® LPR) was placed to reinforce the abdominal wall using a laparoscopic, robotic, or open surgical approach. Post-operative follow-up was performed at 1 month and 1 year. Hernia recurrence was determined by physical examination and, when necessary, via computed tomography scan. Secondary endpoints included length of hospital stay, time to return to work, and hospital readmissions. Evaluated complications of the wound/repair site included presence of surgical site infection, seroma, hematoma, wound dehiscence, or fistula formation.
RESULTS: The observational study cohort included 16 male and 12 female patients with average age of 58.5 years ± 16.3 years and average body mass index of 26.2 kg/m2 ± 4.1 kg/m2. Patients presented with a parastomal hernia (75.0%), incisional hernia (14.3%), or combined parastomal/incisional hernia (10.7%). Using a laparoscopic (53.6%), robotic (35.7%), or open (10.7%) technique, RTMs (OviTex® LPR: 82.1%, OviTex® 1S: 17.9%) were placed using sublay (82.1%) or intraperitoneal onlay (IPOM; 17.9%) mesh positioning. At 1-month and 1-year follow-ups, there were no hernia recurrences (0%). Average hospital stays were 2.1 d ± 1.2 d and return to work occurred at 8.3 post-operative days ± 3.0 post-operative days. Three patients (10.7%) were readmitted before the 1-month follow up due to mesh infection and/or gastrointestinal issues. Fistula and mesh infection were observed in two patients each (7.1%), leading to partial mesh removal in one patient (3.6%). There were no complications between 1 month and 1 year (0%).
CONCLUSIONS: RTMs were used successfully to treat parastomal and incisional hernias at ileostomy reversal, with no hernia recurrences and favorable outcomes after 1-month and 1-year.
OBJECTIVE: To evaluate the effectiveness of using an RTM to reinforce the abdominal wall at stoma takedown sites.
METHODS: Twenty-eight patients were selected with a parastomal and/or incisional hernia who had received a temporary ileostomy or colostomy for fecal diversion after rectal cancer treatment or trauma. Following hernia repair and proximal stoma closure, RTM (OviTex® 1S permanent or OviTex® LPR) was placed to reinforce the abdominal wall using a laparoscopic, robotic, or open surgical approach. Post-operative follow-up was performed at 1 month and 1 year. Hernia recurrence was determined by physical examination and, when necessary, via computed tomography scan. Secondary endpoints included length of hospital stay, time to return to work, and hospital readmissions. Evaluated complications of the wound/repair site included presence of surgical site infection, seroma, hematoma, wound dehiscence, or fistula formation.
RESULTS: The observational study cohort included 16 male and 12 female patients with average age of 58.5 years ± 16.3 years and average body mass index of 26.2 kg/m2 ± 4.1 kg/m2. Patients presented with a parastomal hernia (75.0%), incisional hernia (14.3%), or combined parastomal/incisional hernia (10.7%). Using a laparoscopic (53.6%), robotic (35.7%), or open (10.7%) technique, RTMs (OviTex® LPR: 82.1%, OviTex® 1S: 17.9%) were placed using sublay (82.1%) or intraperitoneal onlay (IPOM; 17.9%) mesh positioning. At 1-month and 1-year follow-ups, there were no hernia recurrences (0%). Average hospital stays were 2.1 d ± 1.2 d and return to work occurred at 8.3 post-operative days ± 3.0 post-operative days. Three patients (10.7%) were readmitted before the 1-month follow up due to mesh infection and/or gastrointestinal issues. Fistula and mesh infection were observed in two patients each (7.1%), leading to partial mesh removal in one patient (3.6%). There were no complications between 1 month and 1 year (0%).
CONCLUSIONS: RTMs were used successfully to treat parastomal and incisional hernias at ileostomy reversal, with no hernia recurrences and favorable outcomes after 1-month and 1-year.
摘要：
背景：腹壁缺陷或无力是临时造口术的常见并发症，切口疝常在结肠造口术或回肠造口术后发展。使用合成网加固腹壁已减少了疝气的发生。生物网格也被用来增强愈合，特别是在受污染的条件下。强化组织基质（RTM），其中包括天然细胞外基质的生物支架和用于增加强度/耐久性的合成组件，旨在利用合成和生物材料的各个方面。迄今为止,尚未报道RTM在造口逆转后可增强腹壁。
目的：评估使用RTM加固造口腹壁的有效性。
方法：选择28例直肠癌治疗或外伤后接受临时回肠造口术或结肠造口术的造口旁和/或切口疝患者。疝修补和近端造口闭合后，放置RTM（OviTex®1S永久性或OviTex®LPR），以使用腹腔镜增强腹壁，机器人,或开放式手术方法。术后随访1个月和1年。通过体格检查确定疝复发，必要时,通过计算机断层扫描。次要终点包括住院时间，回到工作的时间,再入院。评估的伤口/修复部位的并发症包括手术部位感染的存在，血清肿,血肿,伤口裂开,或瘘管形成。
结果：观察性研究队列包括16名男性和12名女性患者，平均年龄为58.5岁±16.3岁，平均体重指数为26.2kg/m2±4.1kg/m2。患者出现造口旁疝（75.0%），切口疝（14.3%），或合并造口旁/切口疝（10.7％）。使用腹腔镜（53.6%），机器人(35.7%)，或开放式(10.7%)技术，RTM（OviTex®LPR：82.1%，OviTex®1S：17.9％）使用下置式（82.1％）或腹膜内上置式（IPOM；17.9％）网格定位放置。在1个月和1年的随访中，无疝气复发(0%)。平均住院时间为2.1d±1.2d，术后8.3天±3.0天恢复工作。由于网状物感染和/或胃肠道问题，三名患者（10.7％）在1个月随访前再次入院。瘘和网片感染各2例(7.1%),导致一名患者（3.6%）部分网片切除。1个月至1年无并发症(0%)。
结论：RTM在回肠造口术逆转时成功用于治疗造口旁和切口疝，1个月和1年后无疝气复发和良好结局。
目的：评估使用RTM加固造口腹壁的有效性。
方法：选择28例直肠癌治疗或外伤后接受临时回肠造口术或结肠造口术的造口旁和/或切口疝患者。疝修补和近端造口闭合后，放置RTM（OviTex®1S永久性或OviTex®LPR），以使用腹腔镜增强腹壁，机器人,或开放式手术方法。术后随访1个月和1年。通过体格检查确定疝复发，必要时,通过计算机断层扫描。次要终点包括住院时间，回到工作的时间,再入院。评估的伤口/修复部位的并发症包括手术部位感染的存在，血清肿,血肿,伤口裂开,或瘘管形成。
结果：观察性研究队列包括16名男性和12名女性患者，平均年龄为58.5岁±16.3岁，平均体重指数为26.2kg/m2±4.1kg/m2。患者出现造口旁疝（75.0%），切口疝（14.3%），或合并造口旁/切口疝（10.7％）。使用腹腔镜（53.6%），机器人(35.7%)，或开放式(10.7%)技术，RTM（OviTex®LPR：82.1%，OviTex®1S：17.9％）使用下置式（82.1％）或腹膜内上置式（IPOM；17.9％）网格定位放置。在1个月和1年的随访中，无疝气复发(0%)。平均住院时间为2.1d±1.2d，术后8.3天±3.0天恢复工作。由于网状物感染和/或胃肠道问题，三名患者（10.7％）在1个月随访前再次入院。瘘和网片感染各2例(7.1%),导致一名患者（3.6%）部分网片切除。1个月至1年无并发症(0%)。
结论：RTM在回肠造口术逆转时成功用于治疗造口旁和切口疝，1个月和1年后无疝气复发和良好结局。
