Heniford B T, Ramshaw B J
Department of Surgery, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC, USA 28232, USA.
Surg Endosc. 2000 May;14(5):419-23. doi: 10.1007/s004640000179.
Effective surgical therapy for ventral and incisional hernias is problematic. Recurrence rates following primary repair range as high as 25-49%, and breakdown following conventional treatment of recurrent hernias can exceed 50%. As an alternative, laparoscopic techniques offer the potential benefits of decreased pain and a shorter hospital stay. This study evaluates the efficacy of the laparoscopic approach for ventral herniorrhaphy.
A retrospective review was performed for 100 consecutive patients with ventral hernias who underwent laparoscopic repair at our institutions between November 1995 and May 1998. All patients who presented during this period and were candidates for a mesh hernia repair were treated via an endoscopic approach.
One hundred patients underwent a laparoscopic ventral hernia repair. There were 48 men and 52 women. The patients were typically obese, with a mean body mass index (BMI) of 31 kg/m(2). Each had undergone an average of 2.5 (range; 0-8) previous laparotomies. Forty-nine repairs were performed for recurrent hernias. An average of two patients (range; 1-7) had previously failed open herniorhaphies; in 20 cases, intraabdominal polypropylene mesh was present. There were no conversions to open operation. The mean size of the defects was large at 87 cm(2) (range; 1-480). In all cases, the mesh (average, 287 cm(2)) was secured with transabdominal sutures and metal tacks or staples. Operative time and estimated blood loss averaged 88 min (range; 18-270) and 30 cc (range; 10-150). Length of stay averaged 1. 6 days (range; 0-4). There were 12 minor and (two) major complications: cellulitis of the trocar site (two), seroma lasting >4 weeks (three), postoperative ileus (two), suture site pain > 2 weeks (two), urinary retention (one), respiratory distress (one), serosal bowel injury (one), and skin breakdown (one) and bowel injury (one). Both of the latter complications required mesh removal. With an average follow-up of 22.5 months (range; 7-37), there have been (three) recurrences.
The laparoscopic approach to the repair of both primary and recurrent ventral hernias offers a low conversion rate, a short hospital stay, and few complications. At 23 months of follow-up, the recurrence rate has been 3%. Laparoscopic repair should be considered a viable option for any ventral hernia.
腹侧疝和切口疝的有效手术治疗存在问题。初次修补后的复发率高达25% - 49%，复发性疝常规治疗后的失败率可能超过50%。作为一种替代方法，腹腔镜技术具有减轻疼痛和缩短住院时间的潜在益处。本研究评估腹腔镜修补腹侧疝的疗效。
对1995年11月至1998年5月期间在我们机构接受腹腔镜修补的100例连续性腹侧疝患者进行回顾性分析。在此期间就诊且适合使用补片修补疝的所有患者均通过内镜方法治疗。
100例患者接受了腹腔镜腹侧疝修补术。其中男性48例，女性52例。患者通常肥胖，平均体重指数（BMI）为31kg/m²。每位患者平均曾接受过2.5次（范围：0 - 8次）剖腹手术。49例为复发性疝修补。平均有2例（范围：1 - 7例）患者之前开放性疝修补失败；20例患者腹腔内有聚丙烯补片。无一例转为开放手术。缺损平均大小较大，为87cm²（范围：1 - 480cm²）。在所有病例中，补片（平均287cm²）通过经腹缝线和金属钉或吻合器固定。手术时间和估计失血量平均分别为88分钟（范围：18 - 270分钟）和30毫升（范围：10 - 150毫升）。住院时间平均为1.6天（范围：0 - 4天）。有12例轻微并发症和2例严重并发症：套管针部位蜂窝织炎（2例）、血清肿持续超过4周（3例）、术后肠梗阻（2例）、缝线部位疼痛超过2周（2例）、尿潴留（1例）、呼吸窘迫（1例）、浆膜性肠损伤（1例）、皮肤破损（1例）和肠损伤（1例）。后两种并发症均需要取出补片。平均随访22.5个月（范围：7 - 37个月），有3例复发。
腹腔镜修补原发性和复发性腹侧疝的方法具有低中转率、短住院时间和较少并发症的特点。在随访23个月时，复发率为3%。腹腔镜修补应被视为任何腹侧疝的可行选择。
