Cady B, Brooke-Cowden G L
Surg Clin North Am. 1976 Jun;56(3):559-70. doi: 10.1016/s0039-6109(16)40931-x.
The most important aspects of repairing massive hernias, eventrations, or surgically created abdominal wall defects are preoperative preparation of the patient and conservative judgment in indications for use of prosthetic material. Before operation, most patients (excluding those with trauma or severe sepsis) can be prepared electively by progressive preoperative pneumoperitoneum. The procedure is safe, simple, and effective. As described, it involves no special techniques or equipment and may be carried out as an inpatient or outpatient procedure. Prosthetic material should be used only to obviate tension on a suture line, for this must scrupulously be avoided. It should not be used routinely as onlay grafts in small or moderate hernias as primary fascial suturing gives better results with few wound complications when closure without tension is possible. Progressive preoperative pneumoperitoneum, combined when necessary with Marlex mesh to obviate tension, enables closure of even gigantic defects. The technique avoids the severe and sometimes fatal preliminary complications resulting from sudden increase in abdominal pressure and diaphragmatic elevation that accompany replacement of abdominal viscera that have lost their "right of domain" with large hernias or abdominal wall defects. This technique also markedly diminishes postoperative pain and aids satisfactory pulmonary management and thus permits early postoperative mobilization and discharge from the hospital.
修复巨大疝、腹裂或手术造成的腹壁缺损，最重要的方面是患者的术前准备以及在使用修复材料指征方面的保守判断。手术前，大多数患者（创伤或严重脓毒症患者除外）可通过逐步术前气腹术进行择期准备。该方法安全、简单且有效。如前所述，它无需特殊技术或设备，可作为住院或门诊手术进行。修复材料仅应用于消除缝线处的张力，因为必须严格避免这种张力。在小型或中型疝中，不应常规将其用作覆盖移植物，因为在无张力闭合可行时，一期筋膜缝合效果更好，伤口并发症更少。逐步术前气腹术，必要时结合Marlex网片以消除张力，即使是巨大缺损也能实现闭合。该技术避免了因用大疝或腹壁缺损替换失去“领地权”的腹腔脏器而导致的腹压突然升高和膈肌抬高所引起的严重且有时致命的初期并发症。该技术还能显著减轻术后疼痛，有助于进行满意的肺部管理，从而允许术后早期活动和出院。
