Schumpelick V, Klinge U, Welty G, Klosterhalfen B
Chirurgische Klinik, Medizinische Fakultät der RWTH Aachen.
Chirurg. 1999 Aug;70(8):876-87.
The marked reduction in recurrence rates following reinforcement of the abdominal wall by meshes in incisional hernia has promoted their increasingly widespread use. The primary suture in technique failed more than half of the cases; therefore, the closure method needs to be changed and improved, particularly with regard to a possibly underlying defect in collagen metabolism. After more than 100 years of mesh development they are mainly placed in a sublay or onlay position, ePTFE, polyester and polypropylene are preferred. In any case the mesh has to overlap the defect sufficiently because of wound contraction. On the basis of our experience and reports in the literature, the advantages and disadvantages of various mesh techniques and mesh materials are discussed. However, because long-term studies are missing, the relevance of the cumulative risk for long-term complications such as mesh migration and fistula formation, the extent of patient complaints or the potential risk of a persistent foreign-body reaction cannot yet be ascertained. Nevertheless, because there are no surgical alternatives, meshes represent an improvement in hernia surgery that cannot be overestimated.
通过使用补片加强腹壁来降低切口疝复发率的显著效果，促使补片的应用越来越广泛。在技术上，一期缝合超过半数的病例会失败；因此，闭合方法需要改变和改进，尤其是考虑到可能存在的胶原代谢潜在缺陷。经过100多年的补片发展，它们主要放置在腹膜前或覆盖位置，首选的是ePTFE、聚酯和聚丙烯。无论如何，由于伤口收缩，补片必须充分覆盖缺损。基于我们的经验和文献报道，讨论了各种补片技术和补片材料的优缺点。然而，由于缺乏长期研究，诸如补片移位和瘘管形成等长期并发症的累积风险、患者投诉的程度或持续异物反应的潜在风险的相关性尚未确定。尽管如此，由于没有其他手术替代方案，补片在疝手术中的改善作用不可高估。
