Docimo Ludovico, Manzi Fulvio, Sparavigna Luigi, De Rosa Massimo, Granato Felice, Amoroso Vincenzo, Docimo Giovanni, Ferraraccio Franca
Facoltà di Medicina e Chirurgia, Insegnamento di Clinica Chirurgica, 11 Divisione di Chirurgia Generale e dell'Obesità, Seconda Università degli Studi di Napoli, Napoli.
Acta Biomed. 2003;74 Suppl 2:38-40.
An incisional hernia is represented by the escape of organs from their physiologic position through an area of weakness on the surgical scar. An original technique, based on a Rives intervention, which is the golden standard in the treatment of incisional hernias, is presented in this study.
From January 1995 to December 2003, 93 patients underwent surgery for incisional hernia in our Division. The intervention was performed in 52 cases (Group A) with a classic Rives technique, with apposition of a prolene mesh in the subaponeurotic space, and fixation of the mesh with transcutaneous stitches. In 41 cases (Group B) the intervention was performed with a personal technique, with apposition of an "Hertra 0", a rigid and memory controlled mesh between the rectum abdomini muscle and its posterior fascia, tension free without fixation with stitches.
The mean follow-up was of 23 months. In Group A we observed immediately 3 postoperative cases (5%) of intraparietal haematoma, 2 (4%) of subcutaneous haematoma, 4 (7%) of retrofascial haematoma, 4 (7%) of wound infection (in 1 it was necessary to remove the prosthesis), 3 (6%) of respiratory complications, and 1 case (2%) of cardiovascular complication. In Group B we observed only 3 cases (7%) of subcutaneous seroma. The mean postoperative stay was 6 days in both groups. There was no postoperative mortality or relapses.
The presented technique seems to offer advantages in the management of incisional hernia; the use of "Hertra 0" mesh simplifies Rives technique, improving its resistance to infections.
切口疝是指器官通过手术瘢痕处的薄弱区域从其生理位置脱出。本研究介绍了一种基于里夫斯手术的原创技术，里夫斯手术是治疗切口疝的金标准。
1995年1月至2003年12月，我科93例患者接受了切口疝手术。52例（A组）采用经典的里夫斯技术进行干预，在腱膜下间隙置入聚丙烯网片，并用经皮缝线固定网片。41例（B组）采用个人技术进行干预，在腹直肌与其后筋膜之间置入“赫特拉0”（一种刚性且具有记忆控制功能的网片），无张力且无需缝线固定。
平均随访23个月。A组术后立即观察到3例（5%）发生壁内血肿、2例（4%）发生皮下血肿、4例（7%）发生筋膜后血肿、4例（7%）发生伤口感染（其中1例需要取出假体）、3例（6%）发生呼吸并发症以及1例（2%）发生心血管并发症。B组仅观察到3例（7%）皮下血清肿。两组术后平均住院时间均为6天。无术后死亡或复发情况。
所介绍的技术在切口疝的处理中似乎具有优势；使用“赫特拉0”网片简化了里夫斯技术，提高了其抗感染能力。
