Ramshaw B J, Esartia P, Schwab J, Mason E M, Wilson R A, Duncan T D, Miller J, Lucas G W, Promes J
Department of Surgery, Georgia Baptist Medical Center, Atlanta, USA.
Am Surg. 1999 Sep;65(9):827-31; discussion 831-2.
The repair of large and/or recurrent ventral hernias is associated with significant complications and a recurrence rate that can be more than 50 per cent. Laparoscopic ventral herniorrhaphy, a recent development, has been shown to be safe and effective in the repair of ventral hernias. This study retrospectively reviews all ventral hernia repairs over a 3-year period, November 1995 through December 1998, at a community-based teaching hospital. The purpose of the study was to compare open and laparoscopic repairs. A total of 253 ventral hernia repairs were performed during this time, 174 open and 79 laparoscopic. The age, weight, and sex distribution was similar for each group. The hernias in the open group averaged 34.1 cm2 in size, and mesh used averaged 47.3 cm2. In the laparoscopic group, the hernia defect averaged 73.0 cm2, and the mesh size averaged 287.4 cm2. Operative time was longer in the open group, 82.0 versus 58.0 minutes. In the open group, there were 38 (21.8%) minor and 8 (4.6%) major complications, compared with 13 (16.5%) minor and 2 (2.5%) major complications in the laparoscopic group. Hospital stay was shorter for the laparoscopic group, 1.7 versus 2.8 days. At an average follow-up of 21 months (range, 2-40 months), there have been 36 recurrences in the open group (20.7%) compared with 2 recurrences in the laparoscopic group (2.5%). In this series, laparoscopic ventral herniorrhaphy compares favorably to open ventral herniorrhaphy with respect to wound complications, hospital stay, operative time, and recurrence rate.
大型和/或复发性腹疝的修复与显著的并发症以及超过50%的复发率相关。腹腔镜腹疝修补术是一项最新进展，已被证明在腹疝修复中安全有效。本研究回顾性分析了1995年11月至1998年12月这3年期间在一家社区教学医院进行的所有腹疝修补术。该研究的目的是比较开放手术和腹腔镜手术修补。在此期间共进行了253例腹疝修补术，其中174例为开放手术，79例为腹腔镜手术。每组的年龄、体重和性别分布相似。开放手术组的疝平均大小为34.1平方厘米，所用补片平均大小为47.3平方厘米。腹腔镜手术组的疝缺损平均为73.0平方厘米，补片大小平均为287.4平方厘米。开放手术组的手术时间较长，分别为82.0分钟和58.0分钟。开放手术组有38例（21.8%）轻微并发症和8例（4.6%）严重并发症，而腹腔镜手术组有13例（16.5%）轻微并发症和2例（2.5%）严重并发症。腹腔镜手术组的住院时间较短，分别为1.7天和2.8天。平均随访21个月（范围2 - 40个月），开放手术组有36例复发（20.7%），而腹腔镜手术组有2例复发（2.5%）。在本系列研究中，腹腔镜腹疝修补术在伤口并发症、住院时间、手术时间和复发率方面优于开放腹疝修补术。
