Koehler R H, Begos D, Berger D, Carey S, LeBlanc K, Park A, Ramshaw B, Smoot R, Voeller G
Martha's Vineyard Hospital, Oak Bluffs, MA, USA.
Zentralbl Chir. 2003 Aug;128(8):625-30. doi: 10.1055/s-2003-41365.
Laparoscopic ventral incisional hernia repair involves intraabdominal placement of a synthetic mesh, and the possibility of formation of severe visceral adhesions to the prosthesis is a principal concern. Little clinical information based on reoperative findings is available about adhesions to biomaterials placed intraabdominally. We conducted a multi-institutional study of adhesions to implanted expanded polytetrafluoroethylene (ePTFE) mesh at reoperation in patients who had previously undergone laparoscopic incisional hernia repair done with the same mesh implantation technique.
Nine surgeons retrospectively assessed the severity of adhesions to ePTFE mesh at reoperation in 65 patients. For each case, adhesions were assigned a score of 0 to 3, with 0 indicating no adhesions and 3 severe adhesions.
The mean time from mesh implantation to reoperation was 420 days (range, 2-1 739 days). No adhesions were observed in 15 cases. Forty-four cases received an adhesion score of 1, and 6 cases a score of 2; no scores of 3 were assigned. Thus, 59 patients (91 %) had either no or filmy, avascular adhesions. No enterotomies occurred during adhesiolysis.
In this large series of reoperations after laparoscopic incisional hernia repair, no or minimal formation of adhesions to implanted ePTFE mesh was observed in 91 % of cases, and no severe cohesive adhesions were found. Comparative analyses of newer materials based on clinical reoperative findings are warranted to assess the safety of intraabdominally placed meshes.
腹腔镜腹直肌切口疝修补术需在腹腔内放置合成补片，而补片形成严重内脏粘连的可能性是主要关注点。关于腹腔内放置生物材料后粘连情况的再手术相关临床信息较少。我们对曾采用相同补片植入技术进行腹腔镜切口疝修补术的患者再次手术时植入的膨体聚四氟乙烯（ePTFE）补片粘连情况进行了多机构研究。
9位外科医生对65例患者再次手术时ePTFE补片粘连的严重程度进行了回顾性评估。对每个病例，粘连情况按0至3分进行评分，0分表示无粘连，3分表示严重粘连。
从补片植入至再次手术的平均时间为420天（范围2 - 1739天）。15例未观察到粘连。44例粘连评分为1分，6例评分为2分；无评分为3分的情况。因此，59例患者（91%）无粘连或仅有薄的、无血管的粘连。粘连松解过程中未发生肠切开术。
在这一系列大量的腹腔镜切口疝修补术后再次手术病例中，91%的病例未观察到或仅有极少的植入ePTFE补片粘连形成，未发现严重的紧密粘连。有必要基于临床再手术结果对新型材料进行比较分析，以评估腹腔内放置补片的安全性。
