Iannitti David A, Hope William W, Norton H James, Lincourt Amy E, Millikan Keith, Fenoglio Michael E, Moskowitz Mark
Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC 28203, USA.
J Am Coll Surg. 2008 Jan;206(1):83-8. doi: 10.1016/j.jamcollsurg.2007.07.030. Epub 2007 Oct 18.
Abdominal wall hernias are a frequent and formidable challenge for general surgeons. Several different surgical techniques and types of mesh prosthetics are available for repair. We evaluated outcomes of an open ventral hernia repair using a synthetic composite mesh.
We prospectively collected data on consecutive patients undergoing open ventral hernia repair using a synthetic composite mesh from January 1, 2000 to December 31, 2005 at four large medical centers. Four surgeons used a standardized surgical procedure for all patients.
The study consisted of 455 patients with an average age of 56 years; 54% were men. Sixty-nine percent of the patients underwent repairs for recurrent hernias. Mean defect size was 44 cm(2), and mean mesh size was 213 cm(2). Average length of hospital stay was 1.1 days. Thirty-one patients had 33 early complications (7%), and 3 patients (0.7%) required reoperation (one each for seroma, bowel injury, and wound breakdown). Early infection occurred in four patients (0.9%), and one patient required reoperation and graft removal. Late complications occurred in nine patients (2%), with two patients requiring reoperation. Late infections occurred in two patients (0.4%); both required antibiotic treatment. Recurrent hernias were observed in 6 patients (1%; 6 of 450 because of 5 patients with unknown recurrence) at a mean followup of 29.3 months.
In this large multicenter series, open ventral hernia repair using a composite mesh resulted in a short hospital stay, moderate complication rate, low infection rate, and low recurrence rate.
腹壁疝对普通外科医生来说是一个常见且艰巨的挑战。有几种不同的手术技术和类型的网状假体可用于修复。我们评估了使用合成复合补片进行开放性腹疝修补术的效果。
我们前瞻性地收集了2000年1月1日至2005年12月31日在四个大型医疗中心接受使用合成复合补片进行开放性腹疝修补术的连续患者的数据。四位外科医生对所有患者采用标准化手术程序。
该研究包括455例患者，平均年龄56岁；54%为男性。69%的患者接受复发性疝修补术。平均缺损面积为44平方厘米，平均补片面积为213平方厘米。平均住院时间为1.1天。31例患者出现33例早期并发症（7%），3例患者（0.7%）需要再次手术（分别为血清肿、肠损伤和伤口裂开各1例）。4例患者（0.9%）发生早期感染，1例患者需要再次手术并取出补片。9例患者（2%）出现晚期并发症，2例患者需要再次手术。2例患者（0.4%）发生晚期感染；均需要抗生素治疗。平均随访29.3个月时，6例患者（1%；450例中有6例，5例复发情况不明）出现复发性疝。
在这个大型多中心系列研究中，使用复合补片进行开放性腹疝修补术导致住院时间短、并发症发生率中等、感染率低和复发率低。
