Benoit L, Arnal E, Goudet P, Cougard P
Service de chirurgie viscérale et urgence, hôpital général, CHU Dijon, 3, rue du Faubourg-Raines, BP 1519, 21033, Dijon, France.
Ann Chir. 2000 Nov;125(9):850-5. doi: 10.1016/s0003-3944(00)00005-5.
The aim of this retrospective study was to assess Lazaro da Silva's rectus sheath aponeuroplasty technique for repair of midline incisional hernias situated above the arcuate line.
Twenty-six patients underwent surgical repair of a supraumbilical (n = 19) or periumbilical (n = 7) incisional hernia. Six patients had had repeated laparotomies and two of them had recurrent incisional hernia. There were 11 obese patients (42%). Muscle diastasis ranged from 4 to 20 centimeters (mean: 9.7 cm). Three overlapping aponeurotic and peritoneal layers were used. The peritoneal sac was partially or totally incorporated in the repair.
There was one postoperative death at day 5 from acute pancreatitis in a patient with associated cholecystectomy. Postoperative complications occurred in six patients. There were 3 abdominal wall infections. Obesity was the main factor associated with operative complications (p = 0.03). Mean follow-up was 19.1 months. There were 2 recurrences, one of them related to an abdominal wall infection.
The Lazaro da Silva aponeuroplasty technique compares favourably with alternative techniques using mesh implants. It is indicated for incisional hernias less than 20 centimeters wide, situated above the arcuate line.
本回顾性研究旨在评估拉萨罗·达席尔瓦的腹直肌鞘腱膜成形术技术用于修复位于弓状线以上的中线切口疝。
26例患者接受了脐上（n = 19）或脐周（n = 7）切口疝的手术修复。6例患者曾接受过多次剖腹手术，其中2例有复发性切口疝。有11例肥胖患者（42%）。肌肉分离范围为4至20厘米（平均：9.7厘米）。使用了三层重叠的腱膜和腹膜层。腹膜囊部分或全部纳入修复。
1例患者在术后第5天因急性胰腺炎死亡，该患者同时接受了胆囊切除术。6例患者出现术后并发症。有3例腹壁感染。肥胖是与手术并发症相关的主要因素（p = 0.03）。平均随访时间为19.1个月。有2例复发，其中1例与腹壁感染有关。
拉萨罗·达席尔瓦腱膜成形术技术与使用补片植入物的替代技术相比具有优势。它适用于宽度小于20厘米、位于弓状线以上的切口疝。
