Bernard C, Polliand C, Mutelica L, Champault G
Department of Surgery, University Paris XIII, CHU Jean Verdier, Avenue du 14 Juillet, 93143 Bondy Cedex, France.
Hernia. 2007 Aug;11(4):315-20. doi: 10.1007/s10029-007-0222-7. Epub 2007 Apr 12.
Very large and complex incisional hernias, especially those involving loss of abdominal wall, present a particular challenge to the surgeon.
The open intraperitoneal technique was used prospectively for the repair of incisional hernias in a selected group of patients with large defects, often those with major loss of abdominal wall, overweight patients, and previous failures of incisional repair.
Between 1 January 1999 and 31 December 2005, out of 275 patients operated on for incisional hernia repair, 61 of them, most of whom were obese with multiorificial recurrent or giant hernias and contraindicated for laparoscopy, were treated using an open intraperitoneal mesh technique. There were 50 females and 11 males, with a mean age of 61. The median ASA score of the group was 2.3, with a mean BMI of 34 kg/m(2) and a mean hernia surface of 182 cm(2). Sixty-four percent of the patients had undergone one or more previous incisional hernia repairs.
Mean operating time was 130 min, with an average hospital stay of 13 days. None of the patients died. Postoperative complications occurred in 21% of the patients; most of which were minor, but two cases (3.3%) developed deep abscesses requiring surgery and removal of the mesh. A recurrence rate of 5% was found after a mean follow-up of 35 months (8-88).
Open intraperitoneal mesh repair appears to be a good option for the treatment of complex incisional hernia (at least 10 cm in diameter or multiorificial) in obese patients contraindicated for laparoscopy.
非常大且复杂的切口疝，尤其是那些涉及腹壁缺损的切口疝，对外科医生而言是一项特殊挑战。
前瞻性地采用开放腹腔内技术，对一组有大的缺损、通常是腹壁严重缺损、超重患者以及既往切口修补失败的特定患者群体进行切口疝修补。
1999年1月1日至2005年12月31日期间，在275例行切口疝修补手术的患者中，有61例采用开放腹腔内网片技术治疗，其中大多数为肥胖患者，患有多部位复发性或巨大疝且不适合腹腔镜手术。有50名女性和11名男性，平均年龄61岁。该组患者的ASA评分中位数为2.3，平均BMI为34kg/m²，平均疝面积为182cm²。64%的患者曾接受过一次或多次既往切口疝修补。
平均手术时间为130分钟，平均住院时间为13天。无患者死亡。21%的患者发生术后并发症；大多数为轻微并发症，但有2例（3.3%）发生深部脓肿，需要手术并取出网片。平均随访35个月（8 - 88个月）后复发率为5%。
对于不适合腹腔镜手术的肥胖患者，开放腹腔内网片修补似乎是治疗复杂切口疝（直径至少10cm或多部位）的一个良好选择。
