Carbonell A M, Kercher K W, Sigmon L, Matthews B D, Sing R F, Kneisl J S, Heniford B T
Department of General Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
Hernia. 2005 Mar;9(1):22-5. doi: 10.1007/s10029-004-0276-8. Epub 2004 Sep 10.
Lumbar hernias are difficult to repair due to their proximity to bone and inadequate surrounding tissue to buttress the repair. We analyzed the outcome of patients undergoing a novel retromuscular lumbar hernia repair technique. The repair was performed in ten patients using a polypropylene or polytetrafluoroethylene mesh placed in an extraperitoneal, retromuscular position with at least 5 cm overlap of the hernia defect. The mesh was fixed with circumferential, transfascial, permanent sutures and inferiorly fixed to the iliac crest by suture bone anchors. Five hernias were recurrent, and five were incarcerated; seven were incisional hernias, and three were posttraumatic. Back and abdominal pain was the most common presenting symptom. Mean hernia size was 227 cm(2) (60-504) with a mesh size of 620 cm(2) (224-936). Mean operative time was 181 min (120-269), with a mean blood loss of 128 ml (50-200). Mean length of stay was 5.2 days (2-10), and morphine equivalent requirement was 200 mg (47-460). There were no postoperative complications or deaths. After a mean follow-up of 40 months (3-99) there have been no recurrences. Our sublay repair of lumbar hernias with permanent suture fixation is safe and to date has resulted in no recurrences. Suture bone anchors ensure secure fixation of the mesh to the iliac crest and may eliminate a common area of recurrence.
腰椎疝因其靠近骨骼且周围组织不足以支撑修复而难以修复。我们分析了接受新型肌后腰椎疝修补技术患者的治疗结果。对10例患者进行了修补,使用聚丙烯或聚四氟乙烯补片置于腹膜外、肌后位置,疝缺损重叠至少5厘米。补片用环形、经筋膜的永久缝线固定,下方通过缝线骨锚固定于髂嵴。5例疝复发,5例嵌顿;7例为切口疝,3例为创伤后疝。腰背部和腹痛是最常见的症状。平均疝大小为227平方厘米(60-504),补片大小为620平方厘米(224-936)。平均手术时间为181分钟(120-269),平均失血量为128毫升(50-200)。平均住院时间为5.2天(2-10),吗啡等效需求量为200毫克(47-460)。无术后并发症或死亡。平均随访40个月(3-99)后无复发。我们采用永久缝线固定的腰椎疝肌下修补术是安全的,迄今为止未出现复发。缝线骨锚确保补片牢固固定于髂嵴,可能消除一个常见的复发部位。