Brockman J B, Patterson N W, Richardson W S
Department of Surgery, Ochsner Clinic Foundation, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
Surg Endosc. 2004 Mar;18(3):536-9. doi: 10.1007/s00464-003-8159-0. Epub 2004 Jan 14.
There are few reports of overall strength of laparoscopic and open incisional hernia repair.
After anesthesia, a 2-inch circular defect was made in the abdominal wall of 28 female swine. Gore-Tex DualMesh Biomaterial (W. L. Gore & Associates, Flagstaff, AZ) was used for all repairs. Sixteen animals underwent open repair and 12 underwent laparoscopic repair. Burst strength was detected within 2 weeks and at 6 weeks by euthanizing the animals and insufflating the abdominal cavity with water while measuring the intraabdominal pressure until it could no longer be pressurized.
Three events occurred after insufflation: rupture around patch (R), dissection from insufflation or pressure monitoring sites (D), or rectal prolapse (P). Failure after open early repair occurred at 289 (range 219-388) mmHg with 7-R, 1-P and late 289 (196-343) mmHg with 1-R, 6-P. Failure after laparoscopic early repair occurred at 259 (191-388) mmHg with 4-R, 1-P, 1-D and late 291 (140-330) mmHg with 2-R, 1-P, 3-D. Late groups were less likely to rupture.
Both hernia repairs are durable at early and late periods. Tissue ingrowth adds to repair strength. We could not show that one repair was stronger than the other. Nonetheless, laparoscopic repair tended to degrade by dissection, which was our highest pressure event.
关于腹腔镜和开放切口疝修补术的整体强度的报道较少。
麻醉后，在28只雌性猪的腹壁上制造一个2英寸的圆形缺损。所有修补均使用戈尔双网生物材料（W. L. 戈尔公司，弗拉格斯塔夫，亚利桑那州）。16只动物接受开放修补，12只接受腹腔镜修补。在2周和6周时通过对动物实施安乐死并向腹腔内注水同时测量腹腔内压力直至无法再增压来检测破裂强度。
充气后发生了3起事件：补片周围破裂（R）、充气或压力监测部位的剥离（D）或直肠脱垂（P）。开放早期修补失败时的压力为289（范围219 - 388）mmHg，有7例R、1例P，晚期为289（196 - 343）mmHg，有1例R、6例P。腹腔镜早期修补失败时的压力为259（191 - 388）mmHg，有4例R、1例P、1例D，晚期为291（140 - 330）mmHg，有2例R、1例P、3例D。晚期组破裂的可能性较小。
两种疝修补术在早期和晚期都很耐用。组织长入增加了修补强度。我们无法证明一种修补比另一种更强。尽管如此，腹腔镜修补倾向于因剥离而退化，这是我们压力最高的事件。
