Schwab R, Conze J, Willms A, Klinge U, Becker H-P, Schumpelick V
Chirurgische Klinik und Poliklinik der RWTH Aachen.
Chirurg. 2006 Jun;77(6):523-30. doi: 10.1007/s00104-006-1158-7.
Since the use of prosthetic mesh for the surgical repair of inguinal hernias has become increasingly popular, mesh material introduced during a previous operation is being detected in a growing number of patients undergoing surgery for recurrent hernia. This applies to at least 10% of recurrences. Needed is a therapeutic algorithm for the surgical management of recurrent hernias after previous mesh repair.
A total of 672 recurrent hernia repairs performed in hospitals in the German cities Aachen and Koblenz were analysed in order to review clinical practice. In 92 patients (13.7%) who underwent surgery for recurrent hernia, mesh had been used in the previous hernia repairs. Attention was focused on the location of the recurrence in relation to the site of mesh implantation and on the advantages and disadvantages of the various surgical procedures for repairing recurrent hernias. Re-examination was performed with a mean follow-up of 3 years.
Surgeons mostly decided during operation which procedure to use. A transinguinal approach was preferred for patients presenting with recurrent hernia and pain, and mesh material introduced during a previous operation was then explanted. In the case of multiple recurrences, a minimal direct suture repair was used for small defects or a preperitoneal approach for inserting a new, large mesh. The majority of recurrences were medial or suprapubic, especially those occurring after a Lichtenstein repair. After re-examining 87 of 92 patients, nine recurrences (10.3%) were found. Mesh-free suturing methods were affected most frequently. Moderate complaints were reported by 39.1%, and 4.6% suffered from medical chronic pain.
The surgical management of recurrent hernias after previous mesh repair is a particular challenge for surgeons. We introduce a therapeutic algorithm for recurrent hernia surgery after previous mesh implantation based on analysis of clinical practice.
由于使用人工合成补片进行腹股沟疝手术修补越来越普遍，越来越多接受复发性疝手术的患者被检测出在之前的手术中植入了补片材料。这至少占复发性疝的10%。因此需要一种针对先前补片修补术后复发性疝的手术治疗方案。
分析了德国亚琛和科布伦茨两市医院共672例复发性疝修补手术，以回顾临床实践。92例（13.7%）接受复发性疝手术的患者在之前的疝修补术中使用了补片。重点关注复发部位与补片植入部位的关系，以及各种复发性疝修补手术的优缺点。平均随访3年进行复查。
外科医生大多在手术中决定采用何种手术方式。对于出现复发性疝且伴有疼痛的患者，首选经腹股沟入路，然后取出先前手术中植入的补片材料。对于多次复发的情况，小缺损采用最小化直接缝合修补，大缺损则采用腹膜前入路植入新的大补片。大多数复发位于内侧或耻骨上，尤其是在Lichtenstein修补术后发生的复发。在对92例患者中的87例进行复查后，发现9例复发（10.3%）。无补片缝合方法受影响最频繁。39.1%的患者报告有中度不适，4.6%的患者患有慢性疼痛。
先前补片修补术后复发性疝的手术治疗对外科医生来说是一项特殊挑战。我们基于临床实践分析，介绍一种先前补片植入后复发性疝手术的治疗方案。
