Misra M C, Bansal V K, Kulkarni M P, Pawar D K
Department of Surgical Disciplines and Anaesthesiology, All India Institute of Medical Sciences, 5th Floor Room No. 5031, Teaching Block, New Delhi 110029, India.
Surg Endosc. 2006 Dec;20(12):1839-45. doi: 10.1007/s00464-006-0118-0.
Incisional hernia is an important complication of abdominal surgery. Its repair has progressed from a primary suture repair to various mesh repairs and laparoscopic repair. Laparoscopic mesh repair is a promising alternative, and in the absence of consensus, needs prospective randomized controlled trials.
Between April 2003 and April 2005, 66 patients with incisional, primary ventral and recurrent hernias were randomized to receive either open retro-rectus mesh repair or laparoscopic mesh repair. These patients were followed up at 1-, 3-, and 6-month intervals thereafter for a mean of 12.17 months (open repair group) and 13.73 months (laparoscopic repair group).
Lower abdominal hernias after gynecologic operations constituted the majority of the hernias (approximately 50%) in both groups. There was no significant injury to viscera or vessel in either group and no conversions. The defect size was 42.12 cm in the open (group 1) and 65.66 cm2 in the laparoscopic group (group 2), and the prosthesis sizes were, respectively, 152.67 cm2 and 203.83 cm2. The hospital stay was 3.43 days in open group and 1.47 days in laparoscopic group (p = 0.007). There was no significant difference in the pain scores between the two groups. More wound-related infectious complications occurred in the open group (33%) than in the laparoscopic group (6%) (p = 0.013). There was one recurrence in the open repair group (3%) and two recurrences in laparoscopic group (6%) (p = 0.55).
Laparoscopic repair of incisional and ventral hernias is superior to open mesh repair in terms of significantly less blood loss, fewer complications, shorter hospital stay, and excellent cosmetic outcome.
切口疝是腹部手术的一种重要并发症。其修复方式已从一期缝合修复发展到各种补片修复和腹腔镜修复。腹腔镜补片修复是一种有前景的替代方法，由于缺乏共识，需要进行前瞻性随机对照试验。
在2003年4月至2005年4月期间，将66例切口疝、原发性腹疝和复发性疝患者随机分为接受开放腹直肌后补片修复或腹腔镜补片修复两组。此后，对这些患者分别在术后1个月、3个月和6个月进行随访，开放修复组平均随访12.17个月，腹腔镜修复组平均随访13.73个月。
两组中妇科手术后的下腹疝均占大多数（约50%）。两组均未发生明显的脏器或血管损伤，也无中转开腹情况。开放组（第1组）的缺损面积为42.12 cm²，腹腔镜组（第2组）为65.66 cm²，补片大小分别为152.67 cm²和203.83 cm²。开放组的住院时间为3.43天，腹腔镜组为1.47天（p = 0.007）。两组间疼痛评分无显著差异。开放组（33%）发生的与伤口相关的感染并发症比腹腔镜组（6%）多（p = 0.013）。开放修复组有1例复发（3%），腹腔镜组有2例复发（6%）（p = 0.55）。
腹腔镜修复切口疝和腹疝在失血明显减少、并发症更少、住院时间更短以及美容效果极佳方面优于开放补片修复。
