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Trends in Surgical Technique and Outcomes of Ventral Hernia Repair in the United States
Annals of Surgery ( IF 9 ) Pub Date : 2022-08-03 , DOI: 10.1097/sla.0000000000005654
Ryan Howard 1, 2 , Jyothi Thumma 2 , Anne Ehlers 1, 2 , Michael Englesbe 1, 2 , Justin Dimick 1, 2, 3 , Dana Telem 1, 2, 3
Affiliation  

Objective: 

To describe national trends in surgical technique and rates of reoperation for recurrence for patients undergoing ventral hernia repair (VHR) in the United States.

Summary Background Data: 

Surgical options for VHR, including minimally invasive approaches, mesh implantation, and myofascial release, have expanded considerably over the past two decades. Their dissemination and impact on population-level outcomes is not well characterized.

Methods: 

We conducted a retrospective cohort study of Medicare beneficiaries undergoing elective, inpatient umbilical, ventral, or incisional hernia repair between 2007 and 2015. Cox proportional hazards models were used to estimate the adjusted proportion of patients who remained free from reoperation for hernia recurrence up to 5 years after surgery.

Results: 

141,261 patients underwent VHR during the study period. Between 2007 and 2018, the use of minimally invasive surgery increased from 2.1% to 22.2%, mesh use increased from 63.2% to 72.5%, and myofascial release increased from 1.8% to 16.3%. Overall, the 5-year incidence of reoperation for recurrence was 14.1% (95% CI 14.0%-14.1%). Over time, patients were more likely to remain free from reoperation for hernia recurrence 5 years after surgery (2007-2009 reoperation-free survival: 84.9% [95% CI 84.8%-84.9%]; 2010-2012 reoperation-free survival: 85.7% [95% CI 85.6%-85.7%]; 2013-2015 reoperation-free survival: 87.8% [95% CI 87.7%-87.9%]).

Conclusions: 

The surgical treatment of ventral and incisional hernias has evolved in recent decades, with more patients undergoing minimally invasive repair, receiving mesh, and undergoing myofascial release. Although our analysis does not address causality, rates of reoperation for hernia recurrence improved slightly contemporaneous with changes in surgical technique.



中文翻译:

美国腹疝修复手术技术和结果的趋势

客观的: 

描述美国接受腹疝修补术 (VHR) 的患者手术技术和复发再手术率的全国趋势。

摘要背景数据: 

VHR 的手术选择,包括微创方法、网状植入和肌筋膜松解,在过去二十年中已大大扩展。它们的传播和对人口层面结果的影响尚不清楚。

方法: 

我们对 2007 年至 2015 年间接受选择性住院脐疝、腹疝或切口疝修补术的医疗保险受益人进行了一项回顾性队列研究。使用 Cox 比例风险模型来估计因疝气复发而无需再次手术的患者的调整比例,最多 5手术后数年。

结果: 

研究期间,141,261 名患者接受了 VHR 治疗。2007年至2018年间,微创手术的使用从2.1%增加到22.2%,网片的使用从63.2%增加到72.5%,肌筋膜松解从1.8%增加到16.3%。总体而言,5 年复发再次手术发生率为 14.1%(95% CI 14.0%-14.1%)。随着时间的推移,患者更有可能在术后 5 年内不再因疝气复发而再次手术(2007-2009 年无再次手术生存率:84.9% [95% CI 84.8%-84.9%];2010-2012 年无再次手术生存率:85.7 % [95% CI 85.6%-85.7%];2013-2015 年无再次手术生存率:87.8% [95% CI 87.7%-87.9%])。

结论: 

近几十年来,腹侧疝和切口疝的手术治疗不断发展,越来越多的患者接受微创修复、接受补片和肌筋膜松解。尽管我们的分析没有解决因果关系,但随着手术技术的变化,疝气复发的再次手术率略有改善。

更新日期:2022-08-08
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