JOURNAL READING

MESH CHOICE IN VENTRAL HERNIA REPAIR :

SO MANY CHOICE, SO LITTLE TIME

PENULIS :

Putri Yulia Habsari (2012730078)

PEMBIMBING :

Dr. Gatot Sugiharto, Sp. B

Kepaniteraan Klinik Fakultas Kedokteran Universitas Muhammadiyah Jakarta

Stase Bedah RSUD BLUD Sekarwangi

http://www.americanjournalofsurgery.com/article/S0002-9610(13)00130-X
MESH CHOICE IN VENTRAL HERNIA
REPAIR: SO MANY CHOICES,
SO LITTLE TIME

ABSTRACT

BACKGROUND

Currently, >200 meshes are commercially available in the United States. To help

guide appropriate mesh selection, the investigators examined the postsurgical

experiences of all patients undergoing ventral hernia repair at their facility from 2008

to 2011 with 12 months of follow-up.

METHODS

A retrospective review of prospectively collected data was conducted. All returns

(surgical readmission, office or emergency visit) for complications or recurrences

were examined. The impact of demographics (age, gender, and body mass index

[BMI]), risk factors (hernia grade, hernia size, concurrent and past bariatric surgery,

concurrent and past organ transplantation, any concurrent surgery, and American

Society of Anesthesiologists score), and prosthetic type (polypropylene, other

synthetic, human acellular dermal matrix, non-cross-linked porcine-derived acellular

dermal matrix, other biologic, or none) on the frequency of return was evaluated.

RESULTS

http://www.americanjournalofsurgery.com/article/S0002-9610(13)00130-X
A total of 564 patients had 12 months of follow-up, and 417 patients had 18 months

of follow-up. In a univariate regression analysis, study arm (biologic, synthetic, or

primary repair), hernia grade, hernia size, past bariatric surgery, and American

Society of Anesthesiologists score were significant predictors of recurrence (P < .

05). Multivariate analysis, stepwise regression, and interaction tests identified three

variables with significant predictive power: hernia grade, hernia size, and BMI. The

adjusted odds ratios vs hernia grade 2 for surgical readmission were 2.6 (95%

confidence interval [CI], 1.3 to 5.1) for grade 3 and 2.6 (95% CI, 1.1 to 6.4) for grade

4 at 12 months and 2.3 (95% CI, 1.1 to 4.6) for grade 3 and 4.2 (95% CI, 1.7 to 10.0)

for grade 4 at 18 months. Large hernia size (adjusted odds ratio vs small size, 3.2;

95% CI, 1.6 to 6.2) and higher BMI (adjusted odds ratio for BMI 50 vs 30 to 34.99

kg/m2, 5.7; 95% CI, 1.2 to 26.2) increased the likelihood of surgical readmission

within 12 months.

CONCLUSIONS

The present data support the hypothesis that careful matching of patient

characteristics to choice of prosthetic will minimize complications, readmissions, and

the number of postoperative office visits.

http://www.americanjournalofsurgery.com/article/S0002-9610(13)00130-X
PEMILIHAN MESH PADA HERNIA VENTRAL
PERBAIKAN: PILIHAN SANGAT BANYAK, WAKTU
SANGAT SEDIKIT

ABSTRAK

LATAR BELAKANG
Saat ini,> 200 jerat yang tersedia secara komersial di Amerika
Serikat. Untuk membantu memandu pilihan jala yang tepat, para
peneliti meneliti pengalaman pascaoperasi dari semua pasien yang
menjalani perbaikan hernia ventral di fasilitas mereka 2008-2011
dengan 12 bulan follow-up.

METODE
Sebuah kajian retrospektif data prospektif yang dikumpulkan
dilakukan. Semua kembali (diterima kembali bedah, kantor atau

http://www.americanjournalofsurgery.com/article/S0002-9610(13)00130-X
kunjungan darurat) untuk komplikasi atau kambuh diperiksa.
Dampak demografi (usia, jenis kelamin, dan indeks massa tubuh
[BMI]), faktor risiko (hernia kelas, ukuran hernia, bersamaan dan
masa lalu operasi bariatrik, bersamaan dan transplantasi organ
masa lalu, setiap operasi bersamaan, dan American Society of
Anesthesiologists skor) , dan jenis prostetik (polypropylene, sintetis
lainnya, matriks dermal aseluler manusia, non-cross-linked babi
yang diturunkan matrix acellular dermal, biologis lainnya, atau
tidak) pada frekuensi pengembalian dievaluasi.

HASIL
Sebanyak 564 pasien memiliki 12 bulan masa tindak lanjut, dan 417
pasien memiliki 18 bulan masa tindak lanjut. Dalam analisis regresi
univariat, lengan studi (biologis, sintetik, atau perbaikan primer),
hernia kelas, ukuran hernia, operasi bariatrik masa lalu, dan
American Society of Anesthesiologists skor adalah prediktor
signifikan dari kekambuhan (P <0,05). analisis multivariat, regresi
bertahap, dan interaksi tes mengidentifikasi tiga variabel dengan
kekuatan yang signifikan prediksi: hernia kelas, ukuran hernia, dan
BMI. odds rasio yang disesuaikan vs hernia kelas 2 untuk diterima
kembali bedah 2,6 (95% confidence interval [CI], 1,3-5,1) untuk
kelas 3 dan 2,6 (95% CI, 1,1-6,4) untuk kelas 4 pada 12 bulan dan
2,3 (95 % CI, 1,1-4,6) untuk kelas 3 dan 4,2 (95% CI, 1,7-10,0) untuk
kelas 4 pada 18 bulan. ukuran besar hernia (rasio odds yang
disesuaikan vs ukuran kecil, 3,2; 95% CI, 1,6-6,2) dan BMI yang lebih
tinggi (rasio odds yang disesuaikan untuk BMI 50 vs 30-34,99 kg /
m2, 5,7; 95% CI, 1,2-26,2) meningkatkan kemungkinan diterima
kembali bedah dalam waktu 12 bulan.

http://www.americanjournalofsurgery.com/article/S0002-9610(13)00130-X
KESIMPULAN
Data ini mendukung hipotesis bahwa pencocokan hati-hati
karakteristik pasien untuk pilihan prostetik akan meminimalkan
komplikasi, readmissions, dan jumlah kunjungan kantor pasca
operasi

http://www.americanjournalofsurgery.com/article/S0002-9610(13)00130-X