Schuster Rob, Curet Myriam J, Alami Ramzi S, Morton John M, Wren Sherry M, Safadi Bassem Y
Department of Surgery, Palo Alto Veterans Health Care System, Stanford University School of Medicine, Stanford, CA, USA.
Obes Surg. 2006 Sep;16(9):1205-8. doi: 10.1381/096089206778392374.
Many patients seeking surgical treatment for morbid obesity present with anterior abdominal wall hernias. Although principles of hernia repair involve a tension-free repair with the use of prosthetic mesh, there is concern about the use of mesh in gastric bypass surgery due to potential contamination with the contents of the gastrointestinal tract and resultant mesh infection. We report our series of patients undergoing Roux-en-Y gastric bypass (RYGBP) and simultaneous anterior abdominal wall hernia repair.
All patients who underwent simultaneous RYGBP surgery and anterior abdominal wall hernia repair were reviewed.
12 patients underwent concurrent RYGBP and anterior wall hernia repair. There were 5 women and 7 men with average age 54.9 +/- 8.5 years (range 35 to 64) and average body mass index (BMI) 50.4 +/- 10.3 kg/m(2) (range 38 to 70). Two open and 10 laparoscopic RYGBP operations were performed. Nine patients (75%) underwent incisional hernia repairs and 3 patients (25%) underwent umbilical hernia repair concurrent with gastric bypass. Average size of defect was 14.7 +/- 13.4 cm(2). One patient had primary repair and 11 patients had prosthetic mesh repair: polypropylene in 3 patients (25%) and polyester in 8 patients (67%). With a 14.1 +/- 9.3 month follow-up, there have been no mesh infections and 2 recurrences, one in the patient who underwent primary repair and one in a patient repaired with polyester mesh but with two previous failed incisional hernia repairs.
Concurrent RYGBP and repair of anterior abdominal wall hernias is safe and feasible. In order to optimize success, tension-free principles of hernia repair with the use of prosthetic mesh should be followed since no mesh infections occurred in our series.
许多寻求手术治疗病态肥胖症的患者同时患有腹壁前疝。虽然疝修补的原则包括使用人工补片进行无张力修补，但由于胃肠道内容物可能污染补片并导致补片感染，因此对于在胃旁路手术中使用补片存在担忧。我们报告了一系列接受Roux-en-Y胃旁路术（RYGBP）并同时进行腹壁前疝修补的患者。
对所有同时接受RYGBP手术和腹壁前疝修补的患者进行了回顾。
12例患者同时接受了RYGBP和前壁疝修补。其中女性5例，男性7例，平均年龄54.9±8.5岁（范围35至64岁），平均体重指数（BMI）为50.4±10.3kg/m²（范围38至70）。进行了2例开放和10例腹腔镜RYGBP手术。9例患者（75%）进行了切口疝修补，3例患者（25%）在胃旁路手术同时进行了脐疝修补。缺损平均大小为14.7±13.4cm²。1例患者进行了一期修补，11例患者进行了人工补片修补：3例患者（25%）使用聚丙烯补片，8例患者（67%）使用聚酯补片。随访14.1±9.3个月，未发生补片感染，有2例复发，1例发生在进行一期修补的患者，1例发生在使用聚酯补片修补但之前有2次切口疝修补失败的患者。
同时进行RYGBP和腹壁前疝修补是安全可行的。为了优化手术效果，应遵循使用人工补片进行疝修补的无张力原则，因为在我们的系列研究中未发生补片感染。
