BACKGROUND:Fascial dehiscence (FD) occurs in up to 14.9% of high-risk patients undergoing emergency laparotomy. Although prophylactic mesh can prevent FD, its use in emergency operations remains controversial. STUDY DESIGN:A prospective randomized clinical trial was conducted at the Hospital das Clínicas from Faculdade de Medicina da Universidade de São Paulo in Brazil. It was performed among high-risk patients, defined according to Rotterdam risk model, undergoing midline emergency laparotomy. The patients were randomized into the suture group (SG), with slowly absorbable running sutures placed with a 36-mm-long needle at a suture-to-wound length ratio of 4:1, and the prophylactic mesh group (PMG), with fascial closure as in the SG but reinforced with onlay polypropylene mesh. The primary end point was incidence of FD at 30 days post operation. RESULTS:We analyzed 115 patients; 52 and 63 were allocated to the SG and PMG, respectively. In all, 77.4% of the cases were for colorectal resection. FD occurred in 7 (13.5%) patients in the SG and none in the PMG (p = 0.003). There was no difference between the groups in number of patients with surgical site occurrence (SSO) or SSO requiring procedural intervention. However, some specific SSOs had higher incidences in the mesh group: surgical site infection (20.6% versus 7.7%; p = 0.05), seroma (19.0% versus 5.8%; p = 0.03), and nonhealing incisional wound (23.8% versus 5.8%; p = 0.008). Of SSOs in the PMG and SG, 92.3% and 73.3%, respectively, resolved spontaneously or with bedside interventions. CONCLUSIONS:Prophylactic onlay mesh reinforcement in emergency laparotomy is safe and prevents FD. Surgical site infection, seroma, and nonhealing incisional wound were more common in the mesh group, but associated with low morbidity within 30 days post operation.

译文

背景:在进行急诊剖腹手术的高危患者中,发生开裂(FD)的发生率高达14.9%。尽管预防性网片可以预防FD,但其在紧急手术中的使用仍存在争议。
研究设计:前瞻性随机临床试验在巴西圣保罗大学医学院的dasClínicas医院进行。该手术是在根据鹿特丹风险模型定义的高危患者中线紧急剖腹手术中进行的。将患者随机分为缝合线组(SG),将可缓慢吸收的缝合线用36毫米长的针以4:1的缝合线与伤口的长度比例放置,而预防性网片组(PMG)如SG中的筋膜封闭,但用聚丙烯网覆盖。主要终点是术后30天的FD发生率。
结果:我们分析了115例患者。分别为SG和PMG分配了52和63。总共有77.4%的病例用于结直肠癌切除。 FD发生在SG的7名患者中(13.5%),而在PMG中没有发生(p = 0.003)。两组之间在手术部位发生(SSO)或需要手术干预的SSO患者之间没有差异。但是,网状组中一些特定的SSO发生率更高:手术部位感染(20.6%对7.7%; p = 0.05),血清肿(19.0%对5.8%; p = 0.03)和切开伤口不愈合(23.8%对5.8) %; p = 0.008)。在PMG和SG中,SSO分别自发地或在床旁干预下消退了,分别为92.3%和73.3%。
结论:在紧急剖腹手术中预防性铺网加固是安全的,可预防FD。网状组更常见手术部位感染,血清肿和切开伤口不愈合,但术后30天内发病率较低。

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