Eriksen J R, Gögenur I, Rosenberg J
Department of Surgical Gastroenterology D, Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900 Hellerup, Denmark.
Hernia. 2007 Dec;11(6):481-92. doi: 10.1007/s10029-007-0282-8. Epub 2007 Sep 11.
Surgical treatment of ventral hernias has changed dramatically over the past decades by the introduction of laparoscopy and prosthetic biomaterials for reinforcement of the abdominal wall. There are many meshes available on the market for laparoscopic ventral hernia repair (LVHR), and new meshes are introduced regularly. Experimental and clinical documentation for safety and efficacy are, however, often not available for the clinician. The choice of mesh may therefore be difficult in clinical practice. We present a review of the current literature regarding safety measures such as adhesions, fistulas, and infections as well as the available data on pain, recurrence, mesh shrinkage, and seroma formation after LVHR.
The literature was searched systematically using PubMed/MEDLINE and EMBASE for controlled studies, prospective descriptive series and retrospective case series.
The literature clearly points in the direction of very few mesh-related complications after LVHR. Experimental studies and theoretical considerations may argue for using a covered mesh, i.e., a composite mesh, or ePTFE for LVHR in humans, although it is important to stress that there are no human data at the moment to support this. Concerns about using pure polypropylene mesh in the intraperitoneal position may be re-evaluated with the experience of lightweight macropore meshes from open surgery in mind. There is a tendency towards greater shrinkage in ePTFE-based meshes but no differences seems to exist between different mesh materials in other relevant outcome parameters from clinical series.
The literature cannot give general recommendations for choice of mesh based on randomized controlled trials. The final choice of mesh for LVHR will therefore typically be based on surgeons' preference and cost while we await further data from randomized controlled clinical trials.
在过去几十年中，随着腹腔镜技术的引入以及用于加强腹壁的人工生物材料的应用，腹疝的外科治疗发生了巨大变化。市场上有许多用于腹腔镜腹疝修补术（LVHR）的补片，并且新的补片也在不断推出。然而，临床医生通常无法获得关于安全性和有效性的实验及临床文献资料。因此，在临床实践中选择补片可能会很困难。我们对当前有关粘连、瘘管和感染等安全措施的文献以及LVHR术后疼痛、复发、补片收缩和血清肿形成的现有数据进行了综述。
系统检索PubMed/MEDLINE和EMBASE数据库，查找对照研究、前瞻性描述性系列研究和回顾性病例系列研究。
文献明确指出LVHR术后与补片相关的并发症极少。实验研究和理论思考可能支持在人体LVHR中使用覆盖补片，即复合补片或膨体聚四氟乙烯（ePTFE），不过需要强调的是，目前尚无人体数据支持这一点。鉴于开放手术中使用轻质大孔补片的经验，对于在腹腔内使用纯聚丙烯补片的担忧可能需要重新评估。基于ePTFE的补片有更大收缩的趋势，但在临床系列的其他相关结局参数方面，不同补片材料之间似乎没有差异。
基于随机对照试验，文献无法给出关于补片选择的一般性建议。因此，在等待随机对照临床试验的进一步数据期间，LVHR补片的最终选择通常将基于外科医生的偏好和成本。
