Williams R F, Martin D F, Mulrooney M T, Voeller G R
Department of Surgery, University of Tennessee Health Science Center, 50 Humphreys Center, #30, Memphis, TN 38120, USA.
Hernia. 2008 Apr;12(2):141-5. doi: 10.1007/s10029-007-0300-x. Epub 2007 Nov 17.
Recurrence rates for open repair of ventral/incisonal hernias historically range from 6% for the classic Rives-Stoppa repair to 35-45% for some of the techniques more commonly used in the United States. We report a modification to the classic Rives-Stoppa repair that allows intraperitoneal placement of the prosthetic, secured with a running suture. The abdominal muscles are closed over the mesh to protect it from any superficial wound problems that might develop and to restore normal architecture of the abdominal wall.
A chart review was undertaken on all patients undergoing open ventral incisional hernia repair by a single surgeon from 2000 to 2006. All hernias were repaired with the intraperitoneal modification mimicking the principles of the Rives-Stoppa repair. Patient characteristics and operative and postoperative data were collected. Primary outcome was recurrence of hernia. Secondary outcomes were complications and rate of mesh infection.
One hundred and fifteen patients were evaluated. Thirty-four patients had repair of recurrent ventral hernias. The average patient was obese, female, and 59 years old. Twenty-five patients used tobacco, eleven were diabetic, and seven used chronic corticosteroids. Meshes utilized included ePTFE, coated polyester, coated polypropylene, and biologic mesh. Average size of mesh was 465.4 cm2. There were four recurrences (3.4%), three of which were due to mesh infection requiring mesh removal. Recurrence rate not secondary to mesh removal was 0.9%. Complications occurred in 26% with seroma formation being the most frequent (16%).
The intraperitoneal modification to the original Rives-Stoppa repair leads to a very low recurrence rate for large ventral hernia repairs with minimal complications and low rate of mesh infection.
历史上，腹侧/切口疝开放修补术的复发率从经典的里夫斯-斯托帕修补术的6%到美国一些更常用技术的35%-45%不等。我们报告了对经典里夫斯-斯托帕修补术的一种改良方法，该方法允许将假体置于腹腔内，并用连续缝合固定。腹部肌肉在补片上方闭合，以保护补片免受可能出现的任何浅表伤口问题影响，并恢复腹壁的正常结构。
对2000年至2006年由一名外科医生进行开放腹侧切口疝修补术的所有患者进行病历回顾。所有疝均采用模仿里夫斯-斯托帕修补术原则的腹腔内改良方法进行修补。收集患者特征以及手术和术后数据。主要结局是疝复发。次要结局是并发症和补片感染率。
共评估了115例患者。34例患者接受复发性腹侧疝修补术。患者平均为肥胖女性，年龄59岁。25例患者吸烟，11例患有糖尿病，7例使用慢性皮质类固醇。使用的补片包括ePTFE、涂层聚酯、涂层聚丙烯和生物补片。补片平均尺寸为465.4平方厘米。有4例复发（3.4%），其中3例是由于补片感染需要取出补片。非补片取出导致的复发率为0.9%。26%的患者出现并发症，最常见的是血清肿形成（16%）。
对原始里夫斯-斯托帕修补术的腹腔内改良方法导致大型腹侧疝修补术的复发率极低，并发症极少，补片感染率也很低。
