Verbo Alessandro, Petito Luigi, Manno Alberto, Coco Claudio, Mattana Claudio, Lurati Massimo, Pedretti Giorgio, Rizzo Gianluca, Sermoneta Daniel, Lodoli Claudio, Nunziata Joseph, D'Ugo Domenico
Department of Surgery, Università Cattolica del Sacro Cuore, Rome, Italy.
J Laparoendosc Adv Surg Tech A. 2007 Oct;17(5):591-5. doi: 10.1089/lap.2006.0133.
Incisional hernias are one of the most frequent complications of open abdominal surgery. The incidence of relapses after a conventional repair procedure is higher in recurrent than in primary cases (30%-50% vs. 11%-20%). The laparoscopic approach can prevent the complications associated with the conventional approach when dealing with recurrent incisional hernias. The aim of this study was to evaluate the efficacy of laparoscopic treatment in such cases.
We prospectively analyzed data from 41 consecutive patients with recurrent incisional hernias, who submitted to a laparoscopic repair procedure with an expanded polytetrafluoroethylene Dual Mesh (Gore-Tex Dual Mesh Plus Biomaterial; W.L. Gore 8 Associates) from December 2001 to December 2004. All of the patients underwent clinical follow-up at 1, 6, and 12 months and then yearly. An ultrasound scan of the abdominal wall was performed at 6 and 12 months after the procedure. The parameters considered for the analysis were: mesh size, operating time, hospital stay, postoperative complications, and recurrences.
The defects were usually localized along midline laparotomies. The mean mesh size was 400 cm2, the mean operating time was 68 minutes, and the mean length of hospital stay was 2.7 days. Complications were encountered in 17% of patients. The mean follow-up was 38 months (range, 18-54). Recurrence was reported in 1 case only (2.4%), which occurred within the first 6 months after the operation.
The laparoscopic repair of recurrent incisional hernia seems to be an effective alternative to the conventional approach, as it can give lower recurrence and complication rates.
切口疝是开腹手术最常见的并发症之一。复发性切口疝经传统修复手术后的复发率高于原发性病例（30%-50% 对比 11%-20%）。在处理复发性切口疝时，腹腔镜手术方法可预防与传统方法相关的并发症。本研究的目的是评估腹腔镜治疗此类病例的疗效。
我们前瞻性分析了2001年12月至2004年12月期间连续41例复发性切口疝患者的数据，这些患者接受了使用膨体聚四氟乙烯双层补片（戈尔双层补片加生物材料；W.L. 戈尔联合公司）的腹腔镜修复手术。所有患者在术后1、6和12个月进行临床随访，之后每年随访一次。术后6个月和12个月进行腹壁超声检查。分析所考虑的参数包括：补片大小、手术时间、住院时间、术后并发症和复发情况。
缺损通常位于中线剖腹手术切口处。平均补片大小为400平方厘米，平均手术时间为68分钟，平均住院时间为2.7天。17%的患者出现并发症。平均随访时间为38个月（范围18 - 54个月）。仅1例（2.4%）报告复发，发生在术后前6个月内。
腹腔镜修复复发性切口疝似乎是传统方法的一种有效替代方案，因为它可降低复发率和并发症发生率。
