Hernia : the journal of hernias and abdominal wall surgery · 2024
Mesh-related complications and recurrence after incisional hernia repair in patients with fistulizing versus non-fistulizing Crohn's disease.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Lovén Hans, Erichsen Rune, Tøttrup Anders, Bisgaard Thue
Аннотация
PURPOSE: Patients with Crohn's disease (CD) frequently undergo multiple abdominal operations, which increase the risk of incisional hernia repair (IHR) and associated mesh-related complications. Patients with intra-abdominal fistulizing CD (FCD) may be more susceptible to mesh-related complications than patients with non-fistulizing CD (non-FCD). The primary objective was to evaluate the risk of reoperation due to mesh-related complications after IHR in patients with FCD and non-FCD. Secondarily, the study evaluated the impact of isolated perianal fistulizing CD on mesh-related complications and the difference in hernia recurrence reoperation rates between FCD and non-FCD patients.
METHODS: This nationwide study followed patients from 30 days after their first recorded IHR until reoperation due to mesh-related complications or hernia recurrence. Cumulative incidence proportion and Cox regression analysis were used to estimate the risk of these outcomes.
RESULTS: A total of 334 patients with CD (FCD, n = 55; non-FCD, n = 279) underwent IHR between 2007 and 2016 with a follow-up rate of 100%. FCD patients had a significantly higher 5 year risk of reoperation for mesh-related complications (HR 15.95, 95% CI 4.29-59.35) compared with non-FCD patients. None of the patients with isolated perianal fistulizing disease required a reoperation for mesh-related complications. The overall risk of reoperation for recurrence was 8.7%, and did not vary significantly between FCD and non-FCD patients (HR 1.06, 95% CI 0.44-2.58).
CONCLUSIONS: FCD may be associated with higher rates of mesh-related complications compared with non-FCD, although larger studies are needed to confirm this finding. Conversely, isolated perianal fistulas do not appear to be associated with an increased risk of mesh-related complications. The benefits associated with mesh should be balanced with the risk of long-term mesh-related complications in patients with FCD.
METHODS: This nationwide study followed patients from 30 days after their first recorded IHR until reoperation due to mesh-related complications or hernia recurrence. Cumulative incidence proportion and Cox regression analysis were used to estimate the risk of these outcomes.
RESULTS: A total of 334 patients with CD (FCD, n = 55; non-FCD, n = 279) underwent IHR between 2007 and 2016 with a follow-up rate of 100%. FCD patients had a significantly higher 5 year risk of reoperation for mesh-related complications (HR 15.95, 95% CI 4.29-59.35) compared with non-FCD patients. None of the patients with isolated perianal fistulizing disease required a reoperation for mesh-related complications. The overall risk of reoperation for recurrence was 8.7%, and did not vary significantly between FCD and non-FCD patients (HR 1.06, 95% CI 0.44-2.58).
CONCLUSIONS: FCD may be associated with higher rates of mesh-related complications compared with non-FCD, although larger studies are needed to confirm this finding. Conversely, isolated perianal fistulas do not appear to be associated with an increased risk of mesh-related complications. The benefits associated with mesh should be balanced with the risk of long-term mesh-related complications in patients with FCD.