Petersen Sven, Henke Gabriele, Zimmermann Leonore, Aumann Georg, Hellmich Gunter, Ludwig Klaus
Department of General and Abdominal Surgery, Dresden-Friedrichstadt Hospital, Teaching Hospital Technical University Dresden, Germany.
Plast Reconstr Surg. 2004 Dec;114(7):1754-60. doi: 10.1097/01.prs.0000142419.40722.c6.
Sublay prosthetic herniorrhaphy has become a widely accepted procedure for incisional hernias. To evaluate the effect of fascia closure on top of mesh repair on infection, and the recurrence rate, the authors reviewed their data regarding herniorrhaphy in the sublay technique. This study was a retrospective analysis of 175 consecutive patients who underwent hernia repair by implantation of prostheses by means of the Stoppa-Rives technique from December of 1994 to December of 2001. All 175 patients had the mesh implanted in the subfascial plane, 130 received a light-weight or heavy-weight polypropylene mesh (Vypro or Prolene) (74 percent), eight had a polyester mesh (Mersilene) (5 percent), and 37 had an expanded polytetrafluoroethylene patch (Gore-Tex) (21 percent). After sublay mesh positioning, the mesh could not be covered by the fascia in 50 cases; in 31 of these cases, a second mesh was placed into the fascial defect. To evaluate the influence of the fascia closing procedure on top of the sublay mesh, three groups were differentiated: initial fascia closure (n = 125), no fascia closure and concomitant mesh interposition (n = 31), and no fascia closure without mesh interposition (n = 19). After a mean follow-up of 20 months, 11 deep prosthetic infections (8 percent) and 15 hernia recurrences (9 percent) were observed. There was an increased risk of mesh infection when the fascia could not be closed, but there was no influence of fascia closure on hernia recurrence. When the fascia was left open, the placement of a second mesh inlay technique reduced mesh infection. The authors' data give evidence that closing the ventral fascia after mesh repair in the sublay position is beneficial. When the edges of the hernia defect could not be approximated, the suturing of a second mesh into the fascia defect was a useful tool for reducing the prosthetic infection rate; however, no significant influence on hernia recurrence was observed.
腹膜前补片疝修补术已成为广泛接受的切口疝治疗方法。为评估在补片修补基础上进行筋膜关闭对感染及复发率的影响，作者回顾了其采用腹膜前技术进行疝修补的数据。本研究是对1994年12月至2001年12月期间连续175例行Stoppa-Rives技术假体植入疝修补术患者的回顾性分析。175例患者均将补片植入筋膜下平面，130例使用轻量或重量聚丙烯补片（Vypro或Prolene）（74%），8例使用聚酯补片（Mersilene）（5%），37例使用膨化聚四氟乙烯补片（Gore-Tex）（21%）。腹膜前补片放置后，50例补片未被筋膜覆盖；其中31例在筋膜缺损处放置了第二片补片。为评估筋膜关闭操作对腹膜前补片的影响，分为三组：初始筋膜关闭组（n = 125）、不进行筋膜关闭且同时进行补片置入组（n = 31）、不进行筋膜关闭且不进行补片置入组（n = 19）。平均随访20个月后，观察到11例深部假体感染（8%）和15例疝复发（9%）。筋膜无法关闭时补片感染风险增加，但筋膜关闭对疝复发无影响。当筋膜开放时，采用第二片补片嵌入技术可降低补片感染。作者的数据表明，腹膜前位置补片修补后关闭腹侧筋膜是有益的。当疝缺损边缘无法对合时，将第二片补片缝合至筋膜缺损处是降低假体感染率的有效方法；然而，未观察到对疝复发有显著影响。
