Kurzer M, Belsham P A, Kark A E
British Hernia Centre, 87 Watford Way, NW4 4RS, London, UK.
Hernia. 2004 May;8(2):104-7. doi: 10.1007/s10029-003-0182-5. Epub 2004 Mar 13.
Umbilical hernias are a common surgical problem with a high recurrence rate using conventional suture techniques. This prospective study examined the feasibility of tension-free mesh repair as a day case using local anaesthetic (LA) for all primary umbilical hernias.
Fifty-four patients (eight women) were operated on; 49 using LA. Through a periumbilical skin incision the margins of the sac were freed from the edges of the defect, and a space was made in the extraperitoneal plane. In defects <3 cm in diameter, a cone of polypropylene (pp) mesh was inserted and attached with nonabsorbable sutures. In defects >3 cm, a flat piece of pp mesh was inserted into the extraperitoneal space as a sublay. No attempt was made to close the fascial defect.
Postoperative pain was graded as mild ( n=37) and moderate ( n=17). No patient had severe postoperative pain. Seven superficial wound infections responded to oral antibiotics. In no case it was necessary to remove the mesh. There were no other complications. Patients were recalled between 2 and 6 years postopertively-mean follow-up 43 months (28- 67). There were no recurrences.
Umbilical hernia repair can be carried out safely and securely under LA with a tension-free mesh technique (cone or a sublay patch) with a low morbidity, negligible recurrence rate, and a high degree of patient satisfaction. It should be the procedure of choice for all such hernias.
脐疝是常见的外科问题，采用传统缝合技术复发率高。本前瞻性研究探讨了采用局部麻醉（LA）在日间手术中对所有原发性脐疝进行无张力补片修补的可行性。
对54例患者（8例女性）进行手术；49例采用局部麻醉。经脐周皮肤切口游离疝囊边缘与缺损边缘，在腹膜外平面制造一个空间。对于直径<3 cm的缺损，插入一个聚丙烯（pp）补片圆锥体并用不可吸收缝线固定。对于直径>3 cm的缺损，将一块扁平的pp补片作为底层补片插入腹膜外间隙。未尝试缝合筋膜缺损。
术后疼痛分级为轻度（n = 37）和中度（n = 17）。无患者术后疼痛严重。7例浅表伤口感染经口服抗生素治疗有效。无一例需要取出补片。无其他并发症。术后2至6年对患者进行随访，平均随访43个月（28 - 67个月）。无复发。
脐疝修补术在局部麻醉下采用无张力补片技术（补片圆锥体或底层补片）可安全可靠地进行，发病率低，复发率可忽略不计，患者满意度高。它应成为所有此类疝修补的首选术式。
