Trojanowski Piotr, Witczak Witold, Najdecki Marek, Stanowski Edward
Wojskowy Instytut Medyczny w Warszawie, Klinika Chirurgii Ogólnej, Onkologicznej i Klatki Piersiowej CSK MON.
Pol Merkur Lekarski. 2007 May;22(131):376-8.
Most common hernias among men and women are inguinal hernias (75-80%) and postoperative (incisional) hernias (8-10%). Management of large incisional hernias (hernia gate bigger than 10 cm) both primary and recurrent could be an encounter for a surgeon. In surgical repair of large hernia use of synthetic materials (mesh) is being prefered. Using mesh can significantly decrease recurrence rate (<10%), compare to operations without synthetic grafts where risk of recurrence can reach 50%. One of the methods of surgical treatment of large abdominal hernias is intraperitoneal placing of implants. For such purpose complex meshes (multi-layered) should be used to prevent adhesion of the mesh to the intestines and avoid dangerous complications such as migration of the mesh through the tissues, perforation of the urine bladder, small and large intestine, forming fistulas and blocking intestines.
Presentation of own experience in dealing with patients with large postoperative abdominal hernias using composite meshes: Bard--Composix Mesh, Parietex--Composite Sofradim and Proceed Ethicon.
Since 2003 to 2006 were performed 7 surgical repairs of large abdominal hernia via an open aproach.
3 male, 4 female, average age 47 years old. Every hernia gate was wider than 15 cm. Bard mesh was used three times, Sofradim and Ethicon two times. Mesh was implanted without tension with single sutures and overlap of more than 5 cm from the edge of the hernia gate. Mesh was separated from intestines with greater momentum if it was possible. Anticoagulant and antibiotic preventive therapies were applied as a rule.
Average time of operation was 140 minutes; average time of postoperative hospitalization was 8 days. Only one case was complicated with seroma which was treated with transcutaneous punctures with good result.
(1) Surgical treatment of large abdominal hernia using composite mesh (intraperitoneal). in selected cases has good results. (2) The limiting factor of using presented method is not enough refunding by NFZ of costs of this procedure.
男性和女性中最常见的疝气是腹股沟疝（75 - 80%）和术后（切口）疝（8 - 10%）。大型切口疝（疝门大于10厘米）无论是原发性还是复发性的，其治疗对外科医生来说都可能是一项挑战。在大型疝的手术修复中，合成材料（补片）的使用更为普遍。与不使用合成移植物的手术相比，使用补片可显著降低复发率（<10%），不使用合成移植物时复发风险可达50%。大型腹疝的手术治疗方法之一是将植入物置于腹腔内。为此应使用复合补片（多层）以防止补片与肠道粘连，并避免危险并发症，如补片通过组织移位、膀胱、小肠和大肠穿孔、形成瘘管以及肠梗阻。
介绍使用复合补片（巴德 - Composix补片、百得思 - 复合索法迪姆补片和爱惜康普理灵补片）治疗大型术后腹疝患者的自身经验。
2003年至2006年期间，通过开放手术对7例大型腹疝进行了手术修复。
男性3例，女性4例，平均年龄47岁。每个疝门宽度均超过15厘米。使用巴德补片3次，索法迪姆补片和爱惜康补片各2次。补片无张力植入，用单根缝线缝合，与疝门边缘重叠超过5厘米。尽可能用大网膜将补片与肠道隔开。通常采用抗凝和抗生素预防性治疗。
平均手术时间为140分钟；术后平均住院时间为8天。仅1例出现血清肿并发症，经经皮穿刺治疗效果良好。
（1）在选定病例中，使用复合补片（腹腔内）手术治疗大型腹疝效果良好。（2）使用该方法的限制因素是国家卫生基金对该手术费用的报销不足。
