Stoppa R, Moungar F, Verhaeghe P
CHRU D'Amiens, Hôpital Nord.
J Chir (Paris). 1992 Jun-Jul;129(6-7):335-43.
Among postoperative incisional hernias, mid-epigastric eventrations have peculiar features for physiopathological reasons that are summed up in general and specifically in the first paragraph of this paper; they are characterized by the quick retraction of the lateral belt, with the chondrocostal margin of the thorax participating as the upper limit of the cleft, and by the rapidly irreducible diastasis--hence the importance of an early decision to operate. The authors propose three regular procedures with which they are experienced: repair with a large retromuscular nonabsorbable synthetic tulle prosthesis for extensive epigastric eventrations, fillup aponeuroplasty using the sheath of the rectus abdominis associated with a premuscular patch in case of diastasis or of multiple superimposed orifices and suture associated with a small retromuscular auxiliary patch to treat small incisional hernias. The article, mainly dealing with the technical details of the three procedures and of their variants, is concluded by a brief report of the personal results obtained with a series of 616 postoperative eventrations, including 91 mid-epigastric ones, controlled after an average time lapse of 5.5 years.
在术后切口疝中，中上腹腹裂因生理病理原因具有独特特征，本文总体及在第一段中专门进行了总结；其特征为外侧带迅速回缩，胸廓肋软骨缘作为裂隙上限参与其中，且腹直肌分离迅速难以复位——因此早期决定手术至关重要。作者提出三种他们经验丰富的常规手术方法：对于广泛的中上腹腹裂，使用大型肌后不可吸收合成网片假体进行修复；对于腹直肌分离或多个叠加孔的情况，采用腹直肌鞘进行填充腱膜成形术并联合肌前补片；对于小切口疝，采用缝合联合小型肌后辅助补片进行治疗。本文主要论述了这三种手术方法及其变体的技术细节，最后简要报告了对616例术后腹裂患者（包括91例中上腹腹裂患者）的个人治疗结果，平均随访5.5年后进行评估。
