Robbins S B, Pofahl W E, Gonzalez R P
Department of Surgery, University of South Alabama College of Medicine, Mobile 27858, USA.
Am Surg. 2001 Sep;67(9):896-900.
Postoperative wound complications can be a source of significant morbidity after open ventral hernia repair. By using smaller incisions a laparoscopic approach may decrease this complication. To determine the rate of wound complications after laparoscopic ventral hernia repair prospectively collected data on morbidity in 54 consecutive patients undergoing ventral hernia repair were analyzed. Wound complications were classified as major if there was an open wound or treatment with intravenous antibiotics was required. Minor wound complications consisted of wound erythema or drainage that was treated on an outpatient basis. Eighteen patients underwent open ventral hernia repair. Thirty-six patients underwent attempted laparoscopic repair; five required conversion to an open procedure. Wound complications occurred in 28 and 16 per cent of patients undergoing open and successful laparoscopic repairs, respectively. However, only 3 per cent of patients undergoing laparoscopic repair had a major wound complication as compared with 22 per cent of patients undergoing open herniorrhaphy. Two-thirds of the major wound complications in the attempted laparoscopic group occurred in patients requiring conversion to an open procedure. Laparoscopic ventral hernia repair is a safe and effective alternative to conventional open ventral hernia repair. The main advantage of this minimally invasive approach is a decrease in the rate of major wound complications.
术后伤口并发症可能是开放性腹疝修补术后显著发病的一个原因。通过采用较小的切口，腹腔镜手术方法可能会减少这种并发症。为了确定腹腔镜腹疝修补术后伤口并发症的发生率，对连续54例接受腹疝修补术患者的前瞻性收集的发病率数据进行了分析。如果存在开放性伤口或需要静脉使用抗生素治疗，则伤口并发症被分类为严重。轻微伤口并发症包括伤口红斑或门诊治疗的引流。18例患者接受了开放性腹疝修补术。36例患者尝试进行腹腔镜修补；5例需要转为开放手术。接受开放性和成功腹腔镜修补术的患者中，伤口并发症分别发生在28%和16%。然而，接受腹腔镜修补术的患者中只有3%发生严重伤口并发症，而接受开放性疝修补术的患者中这一比例为22%。在尝试腹腔镜手术组中，三分之二的严重伤口并发症发生在需要转为开放手术的患者中。腹腔镜腹疝修补术是传统开放性腹疝修补术的一种安全有效的替代方法。这种微创方法的主要优点是严重伤口并发症发生率降低。
