Solorzano C C, Minter R M, Childers T C, Kilkenny J W, Vauthey J N
Department of Surgery, University of Florida, Gainesville, USA.
Am J Surg. 1999 Jan;177(1):19-22. doi: 10.1016/s0002-9610(98)00292-x.
Recurrent and complex bilateral inguinal hernias are associated with a high recurrence rate. This study evaluates prospectively the efficacy and safety of giant prosthetic reinforcement of the visceral sac (GPRVS) in a group of patients at high risk for recurrence.
Sixty-four patients with 124 inguinal hernias (60 bilateral and 4 unilateral) underwent repair using a large polyester mesh based on Stoppa's preperitoneal technique. Mean age was 61 years (63 men and 1 woman), and 69% had one or more comorbid medical conditions.
Factors predicating a high risk for recurrence included large hernia size (> or =5 cm; 31%, 20 of 64), failure of one or more previous repairs (39%, 25 of 64), and chronic obstructive pulmonary disease (28%, 18 of 64). Mean operative time was 115 minutes (range 45 to 235). Mean length of stay was 3+/-3 days. There were 2 major and 15 minor complications, no mesh infections, and no death. Follow-up was obtained in 95% (61 of 64). After a mean follow-up of 24 months, the recurrence rate was 1% (1 of 124) per inguinal hernia repaired or 2% (1 of 64) per patient.
GPRVS is a safe and effective addition to the surgeon's armamentarium to treat selected patients with recurrent or complex bilateral inguinal hernias.
复发性及复杂性双侧腹股沟疝的复发率较高。本研究前瞻性评估了巨大补片加强内脏囊（GPRVS）在一组复发高危患者中的疗效及安全性。
64例患者共124例腹股沟疝（60例双侧，4例单侧），采用基于Stoppa腹膜前技术的大聚酯补片进行修补。平均年龄61岁（63例男性，1例女性），69%的患者有一种或多种合并症。
复发高危因素包括疝囊较大（≥5 cm；31%，64例中的20例）、既往一次或多次修补失败（39%，64例中的25例）及慢性阻塞性肺疾病（28%，64例中的18例）。平均手术时间为115分钟（范围45至235分钟）。平均住院时间为3±3天。有2例严重并发症和15例轻微并发症，无补片感染，无死亡病例。95%（64例中的61例）获得随访。平均随访24个月后，每例修补的腹股沟疝复发率为1%（124例中的1例），每位患者的复发率为2%（64例中的1例）。
对于治疗特定的复发性或复杂性双侧腹股沟疝患者，GPRVS是外科医生手术方法中一种安全有效的补充手段。
