Paajanen H, Laine H
Department of Surgery and Anesthesiology, Central Hospital of Mikkeli, Porrassalmenkatu 35-37, 50100 Mikkeli, Finland.
Hernia. 2005 Mar;9(1):62-7. doi: 10.1007/s10029-004-0283-9. Epub 2004 Nov 12.
Surgical repair of very large ventral hernias has become feasible after the introduction of synthetic meshes and developments in intensive-care treatment. In addition to the operative challenges, postoperative disorders in the cardiovascular system, tissue oxygenation, increased intra-abdominal pressure, and pulmonary embolism expose the patient to severe risks.
From 1997-2002 we operated on ten patients with giant ventral incisional or umbilical hernia (mean defect size 240 cm(2)) by using retromuscular polypropylene mesh. All patients were morbidly obese [mean Body Mass Index (BMI) 39+/-7.2 kg/m(2)]. Four of the operations were emergencies because of an acute intestinal occlusion, bowel gangrene, and skin complications. The patients were reinvestigated after the mean follow-up of 2.5 years to find out the frequency of recurrence and degree of disability.
There was no intraoperative mortality, but one patient died at home after 5 weeks because of myocardial infarct and prolonged wound infection. She had mild stable coronary heart disease preoperatively. Although minor wound complications were observed in three patients, there was no need to remove the meshes. One small recurrent hernia was observed in the follow-up, but it was too small to be repaired. The quality of life after surgery was good for all patients, and they were satisfied with the operation. Retromuscular mesh hernioplasty associated with careful patient monitoring in intensive care is safe and feasible in the selected patients with massive ventral hernia.
在合成补片引入及重症监护治疗发展之后，超大腹壁疝的外科修复已变得可行。除了手术挑战之外，心血管系统术后紊乱、组织氧合、腹内压升高及肺栓塞使患者面临严重风险。
1997年至2002年期间，我们对10例巨大腹壁切口疝或脐疝患者（平均缺损面积240 cm²）采用肌后聚丙烯补片进行手术。所有患者均为病态肥胖[平均体重指数（BMI）39±7.2 kg/m²]。其中4例手术为急诊手术，原因是急性肠梗阻、肠坏疽及皮肤并发症。对患者进行平均2.5年的随访后再次检查，以确定复发频率及残疾程度。
术中无死亡病例，但1例患者术后5周在家中因心肌梗死及伤口感染迁延不愈死亡。该患者术前患有轻度稳定型冠心病。虽然3例患者出现轻微伤口并发症，但无需取出补片。随访中发现1例小的复发性疝，但太小无法修复。所有患者术后生活质量良好，对手术满意。对于选定的巨大腹壁疝患者，肌后补片疝修补术结合重症监护中对患者的仔细监测是安全可行的。
