Heniford B T, Park A, Ramshaw B J, Voeller G
Department of Surgery, Carolinas Medical Center, Charlotte, NC 28232, USA.
J Am Coll Surg. 2000 Jun;190(6):645-50. doi: 10.1016/s1072-7515(00)00280-5.
Recurrence rates after primary repair of ventral and incisional hernias range from 25% to 52%. Recurrence after open surgery is less likely if mesh is used, but the wide fascial dissection and required flap creation increase complication rates. Laparoscopic techniques offer an alternative.
To assess the safety and efficacy of laparoscopic ventral and incisional herniorrhaphy, we reviewed the records of all our patients who underwent such a procedure from November 1993 to August 1999. A laparoscopic approach was attempted in all patients considered to require a mesh repair. Patient demographic characteristics, operative details, and outcomes were recorded.
Of 415 patients scheduled to undergo laparoscopic ventral or incisional herniorrhaphy, conversion to an open procedure was necessary in 8. All the remaining 407 patients (205 men and 202 women; mean age 53.2 years; range 13 to 88 years) were included in the study. Mean fascial defect size was 100.1 cm2 (range 1 to 480 cm2). In 97% of patients, expanded polytetrafluoroethylene mesh was used. Mean operating time was 97 minutes (range 11 to 270 minutes). Mean estimated blood loss was 35 mL (range 10 to 150 mL). Average hospital stay was 1.8 days (range 0 to 17 days). There were 53 complications (13.0%), including cellulitis of a trocar site, infection requiring mesh removal, prolonged suture pain, persistent seroma, intestinal injury, hematoma or postoperative bleeding, prolonged ileus, urinary retention, respiratory distress, fever, intraabdominal abscess, and trocar site herniation. There were no deaths. During a mean followup time of 23 months (range 1 to 60 months), there were 14 hernia recurrences (3.4%), 6 in patients in whom only a stapling device (no sutures) had been used to secure the mesh to the abdominal wall.
Laparoscopic repair was completed in 98.1% of patients in whom it was attempted. The complication rate was acceptable. A short hospital stay and minimal blood loss were documented. The recurrence rate was 3.4%. Laparoscopic ventral and incisional hernia repair appear to be safe and effective.
腹侧疝和切口疝一期修补术后的复发率在25%至52%之间。开放手术中使用补片时复发的可能性较小，但广泛的筋膜剥离和所需的皮瓣制作会增加并发症发生率。腹腔镜技术提供了一种替代方法。
为评估腹腔镜腹侧疝和切口疝修补术的安全性和有效性，我们回顾了1993年11月至1999年8月期间所有接受该手术患者的记录。所有被认为需要补片修补的患者均尝试采用腹腔镜方法。记录患者的人口统计学特征、手术细节和结果。
在计划接受腹腔镜腹侧疝或切口疝修补术的415例患者中，8例需要转为开放手术。其余407例患者（205例男性和202例女性；平均年龄53.2岁；范围13至88岁）纳入研究。平均筋膜缺损面积为100.1平方厘米（范围1至480平方厘米）。97%的患者使用了膨化聚四氟乙烯补片。平均手术时间为97分钟（范围11至270分钟）。平均估计失血量为35毫升（范围10至150毫升）。平均住院时间为1.8天（范围0至17天）。共有53例并发症（13.0%），包括套管针部位蜂窝织炎、需要取出补片的感染、缝线疼痛持续时间延长、持续性血清肿、肠损伤、血肿或术后出血、肠梗阻持续时间延长、尿潴留、呼吸窘迫、发热、腹腔内脓肿和套管针部位疝。无死亡病例。在平均23个月（范围1至60个月）的随访期间，有14例疝复发（3.4%），其中6例患者仅使用吻合器（未使用缝线）将补片固定于腹壁。
98.1%尝试进行腹腔镜修补的患者完成了手术。并发症发生率可接受。记录显示住院时间短且失血量极少。复发率为3.4%。腹腔镜腹侧疝和切口疝修补术似乎安全有效。
