LeBlanc K A
Minimally Invasive Surgery Institute, 7777 Hennessy Boulevard, Suite 612, Baton Rouge, LA 70808, USA.
Surg Endosc. 2007 Apr;21(4):508-13. doi: 10.1007/s00464-006-9032-8. Epub 2007 Feb 8.
Laparoscopic repair of incisional and ventral hernias is rapidly becoming more commonplace in the armamentarium of general surgeons. Its utility and low recurrence rates make it a very attractive option. As with all newer procedures, controversies exist with this approach. One significant aspect is the method of fixation for the biomaterial. Most authors add the use of transfascial sutures. Others, in the minority, do not.
A literature search using Medline and PubMed was used to evaluate the best practice for fixation in laparoscopic incisional and ventral hernia repair.
This review of the current literature (including comparative series) seems to show that the recurrence rate is approximately 4% with the use of sutures and 1.8% without their use. However, these data do not show that there is tremendous variation in the method and manner of placing transfascial sutures or that long-term follow-up evaluation is inadequate in most series. No firm conclusions can be drawn about whether it is detrimental to omit the use of transfascial sutures.
On the basis of this review, a larger overlap of the prosthesis (5 vs 3 cm) is necessary if sutures are not used. If sutures are used, they should be placed no more than 5 cm apart. Prospective randomized trials with and without of transfascial sutures using a consistent biomaterial are necessary to settle this issue.
腹腔镜修补切口疝和腹疝在普通外科医生的手术方法中迅速变得越来越常见。其效用和低复发率使其成为一个非常有吸引力的选择。与所有新手术一样，这种方法也存在争议。一个重要方面是生物材料的固定方法。大多数作者会加用经筋膜缝线。少数人则不加用。
使用Medline和PubMed进行文献检索，以评估腹腔镜切口疝和腹疝修补术中固定的最佳做法。
对当前文献（包括比较系列）的综述似乎表明，使用缝线时复发率约为4%，不使用缝线时为1.8%。然而，这些数据并未表明经筋膜缝线的放置方法和方式存在巨大差异，也未表明大多数系列的长期随访评估不足。关于省略经筋膜缝线的使用是否有害，无法得出确凿结论。
基于本综述，如果不使用缝线，需要更大的补片重叠（5厘米对3厘米）。如果使用缝线，缝线间距不应超过5厘米。有必要进行使用一致生物材料且有或无经筋膜缝线的前瞻性随机试验来解决这个问题。
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