Abstract：
OBJECTIVE: Surgical repair of complex abdominal wall hernias remains technically demanding and is widely recognized as a risk factor for unfavorable outcomes with high recurrence and morbidity rates. The objective is to assess short- and long-term complications after open intraperitoneal onlay mesh (IPOM) repair combined with bilateral anterior component separation (ACS) for large and difficult incisional hernias, alongside evaluating hernia recurrence rates.
METHODS: This retrospective analysis utilized data sourced from Hospital electronic health records and a prospective database at an academic tertiary referral center. Data collection was carried out from patients operated between January 2006 and December 2017. Eligible patients had complex incisional hernias measuring at least 10 cm in their transverse diameter and had an open IPOM repair with bilateral ACS.
RESULTS: In our study group of 45 patients, the 30-day surgical site occurrence (SSO) rate was high (37.8%), primarily consisting of superficial postoperative complications as seroma (17.8%) and wound dehiscence (6.7%). Among six patients (13.3%), wound complications escalated to chronic infected mesh-related problems, leading to complete mesh removal in four cases (8.9%) and partial mesh removal in two cases (4.4%). Regarding long-term complications, five patients (11.1%) developed enterocutaneous fistula. The recurrence rate was modest [5 out of 41 (12.2%)] over a median follow-up period of 99 months.
CONCLUSIONS: Despite a high SSO rate, application of the open IPOM technique with ACS could serve as a valuable rescue option for managing large and complex hernias, with acceptable hernia recurrence rates at long-term follow-up.
METHODS: This retrospective analysis utilized data sourced from Hospital electronic health records and a prospective database at an academic tertiary referral center. Data collection was carried out from patients operated between January 2006 and December 2017. Eligible patients had complex incisional hernias measuring at least 10 cm in their transverse diameter and had an open IPOM repair with bilateral ACS.
RESULTS: In our study group of 45 patients, the 30-day surgical site occurrence (SSO) rate was high (37.8%), primarily consisting of superficial postoperative complications as seroma (17.8%) and wound dehiscence (6.7%). Among six patients (13.3%), wound complications escalated to chronic infected mesh-related problems, leading to complete mesh removal in four cases (8.9%) and partial mesh removal in two cases (4.4%). Regarding long-term complications, five patients (11.1%) developed enterocutaneous fistula. The recurrence rate was modest [5 out of 41 (12.2%)] over a median follow-up period of 99 months.
CONCLUSIONS: Despite a high SSO rate, application of the open IPOM technique with ACS could serve as a valuable rescue option for managing large and complex hernias, with acceptable hernia recurrence rates at long-term follow-up.
摘要：
目的：复杂腹壁疝的手术修复在技术上仍然要求很高，并且被广泛认为是不良结局的危险因素，具有高复发率和发病率。目的是评估开放式腹膜内嵌网（IPOM）修复联合双侧前组件分离（ACS）治疗大型和困难的切口疝后的短期和长期并发症。同时评估疝气复发率。
方法：本回顾性分析利用了来自医院电子健康记录和一个学术三级转诊中心的前瞻性数据库的数据。数据收集是从2006年1月至2017年12月期间手术的患者中进行的。符合条件的患者患有复杂的切口疝，其横径至少为10cm，并且在双侧ACS中进行了开放性IPOM修复。
结果：在我们的45名患者的研究组中，30天手术部位发生率（SSO）较高（37.8%），主要包括浅表术后并发症，如血清肿（17.8％）和伤口裂开（6.7％）。在6名患者（13.3%）中，伤口并发症升级为慢性感染网状物相关问题，导致4例（8.9％）完全清除网状物，2例（4.4％）部分清除网状物。关于长期并发症，5例患者（11.1％）发生肠外瘘。在99个月的中位随访期内，复发率适中[41人中有5人（12.2%）]。
结论：尽管SSO率很高，开放式IPOM技术与ACS的应用可以作为管理大型复杂疝的有价值的救援选择，在长期随访中，疝复发率可接受。
方法：本回顾性分析利用了来自医院电子健康记录和一个学术三级转诊中心的前瞻性数据库的数据。数据收集是从2006年1月至2017年12月期间手术的患者中进行的。符合条件的患者患有复杂的切口疝，其横径至少为10cm，并且在双侧ACS中进行了开放性IPOM修复。
结果：在我们的45名患者的研究组中，30天手术部位发生率（SSO）较高（37.8%），主要包括浅表术后并发症，如血清肿（17.8％）和伤口裂开（6.7％）。在6名患者（13.3%）中，伤口并发症升级为慢性感染网状物相关问题，导致4例（8.9％）完全清除网状物，2例（4.4％）部分清除网状物。关于长期并发症，5例患者（11.1％）发生肠外瘘。在99个月的中位随访期内，复发率适中[41人中有5人（12.2%）]。
结论：尽管SSO率很高，开放式IPOM技术与ACS的应用可以作为管理大型复杂疝的有价值的救援选择，在长期随访中，疝复发率可接受。
