Venclauskas Linas, Silanskaite Jolita, Kanisauskaite Jurga, Kiudelis Mindaugas
Department of Surgery, Kaunas University of Medicine, Kaunas, Lithuania.
Medicina (Kaunas). 2007;43(11):855-60.
Ventral hernia is a common problem in general surgery practice. Incisional hernia can develop in 15-25% of patients after abdominal surgery. The aim of this study was to compare two different methods of incisional hernia surgery.
A retrospective analysis of database of surgery department from 1997 to 2000 was performed. All patients were divided into two groups. The first group patients were operated using open suture repair (keel technique); the second group patients--using open mesh repair (onlay technique). Long-term follow-up was done by a mail questionnaire. A special questionnaire was sent to all patients. Postoperative evaluation included pain and discomfort in the abdomen, physical activity, and recurrence rate after operation. Statistical evaluation was conduced using descriptive analysis: the unpaired Student t test to compare parametric criterions between two study groups, Mann-Whitney U test to compare the unpaired nonparametric criterions between two study groups, and chi2 test to investigate nonparametric criterions between these groups.
A total of 202 patients (51 males, 151 females) with incisional hernia were operated during 1997-2000. One hundred seventy-one patients were in the keel technique group, and 31 patients in the onlay technique group. There were no significantly differences in age and sex between these groups. The hospitalization time was significantly longer in the open mesh repair group. The postoperative complication (wound seroma and suppuration) rate was significantly higher in the onlay technique group. One hundred sixty-one patients (79.7%) answered the questionnaire (133 in the keel technique group, 28 the in onlay technique group). The patients' return to physical activity after surgery was significantly longer in the keel technique group. Forty-one patients (31%) had hernia recurrence in the keel technique group and 3 patients (11%) in the onlay technique group (P<0.05). There were no postoperative deaths in both groups.
The rates of postoperative therapeutic complications and hernia recurrence are significantly lower after open mesh repair surgery. Return to normal physical activity after surgery is significantly longer after open suture repair surgery.
腹疝是普通外科常见问题。腹部手术后15% - 25%的患者会发生切口疝。本研究旨在比较两种不同的切口疝手术方法。
对1997年至2000年外科数据库进行回顾性分析。所有患者分为两组。第一组患者采用开放缝合修补术（龙骨技术）；第二组患者采用开放网片修补术（覆盖技术）。通过邮寄问卷进行长期随访。向所有患者发送了一份特殊问卷。术后评估包括腹部疼痛和不适、身体活动情况以及术后复发率。采用描述性分析进行统计评估：采用不成对学生t检验比较两个研究组之间的参数标准，采用曼 - 惠特尼U检验比较两个研究组之间不成对的非参数标准，采用卡方检验研究这些组之间的非参数标准。
1997年至2000年期间，共对202例切口疝患者（51例男性，151例女性）进行了手术。龙骨技术组171例患者，覆盖技术组31例患者。两组患者的年龄和性别无显著差异。开放网片修补组的住院时间显著更长。覆盖技术组的术后并发症（伤口血清肿和化脓）发生率显著更高。161例患者（79.7%）回复了问卷（龙骨技术组133例，覆盖技术组28例）。龙骨技术组患者术后恢复身体活动的时间显著更长。龙骨技术组有41例患者（31%）疝复发，覆盖技术组有3例患者（11%）疝复发（P<0.05）。两组均无术后死亡病例。
开放网片修补术后治疗并发症和疝复发率显著更低。开放缝合修补术后恢复正常身体活动的时间显著更长。
