Martin D F, Williams R F, Mulrooney T, Voeller G R
Department of Surgery, University of Tennessee Health Science Center, Memphis, TN 38120, USA.
Hernia. 2008 Aug;12(4):379-83. doi: 10.1007/s10029-008-0351-7. Epub 2008 Feb 29.
Umbilical and epigastric hernias have historically been repaired without mesh resulting in recurrence rates in some series of up to 40%. Recent data suggests mesh repair of these hernias may decrease recurrent hernia rates. Ideal placement of the mesh is behind the defect, which is difficult to do without a large incision in these hernias unless done laparoscopically. The Ventralex hernia patch is a composite PTFE/polypropylene patch allowing intraperitoneal placement behind the hernia defect through a small incision, and without the cost of laparoscopy. To date, only one study exists evaluating this new prosthesis.
This study is a retrospective chart review of all umbilical and epigastric hernias repaired with the Ventralex hernia patch by a single surgeon. Patient characteristics and operative and post-operative data were collected. Hernia recurrence is the primary outcome. Secondary outcomes include complication rates.
Eighty-eight patients from 2003-2006 were evaluated. The population included patients aged 25-86 (mean 52) with nineteen females (22%). The average BMI was 32 (range 18-68). Eighteen patients were smokers, five patients were diabetic, and two patients were chronic steroid users. The size of patches used were small (72%), medium (27%), and unknown (1%). Average operating room time was 52 min (range 19-194). The different types of hernias repaired were umbilical (68%), epigastric (30%), and incisional (2%). Follow-up visits ranged from 8 days to 3.1 years in all but five patients (6%). No hernia recurrences were found in follow-up. Complications included two patients (2.2%) with mesh infection requiring removal of the patch, one patient with post-operative urinary retention, and seroma formation in another patient.
The composite PTFE/polypropylene hernia patch is effective in preventing hernia recurrence in umbilical, epigastric, and small ventral hernia repairs and can be accomplished with a low rate of complications.
脐疝和上腹疝历来在无补片的情况下进行修补，在某些系列研究中复发率高达40%。最近的数据表明，这些疝的补片修补可能会降低复发疝的发生率。补片的理想放置位置是在缺损后方，在这些疝中，若不做一个大切口则很难做到这一点，除非通过腹腔镜手术。Ventralex疝修补补片是一种复合聚四氟乙烯/聚丙烯补片，可通过小切口在疝缺损后方进行腹腔内放置，且无需腹腔镜手术的费用。迄今为止，仅有一项研究对这种新型假体进行了评估。
本研究是对一位外科医生使用Ventralex疝修补补片修补的所有脐疝和上腹疝进行的回顾性病历审查。收集了患者的特征以及手术和术后数据。疝复发是主要结局。次要结局包括并发症发生率。
对2003年至2006年的88例患者进行了评估。该人群包括年龄在25至86岁（平均52岁）的患者，其中19名女性（22%）。平均体重指数为32（范围18至68）。18例患者吸烟，5例患者患有糖尿病，2例患者长期使用类固醇。所用补片的尺寸为小（72%）、中（27%）和未知（1%）。平均手术时间为52分钟（范围19至194分钟）。修补的不同类型疝为脐疝（68%）、上腹疝（30%）和切口疝（2%）。除5例患者（6%）外，所有患者的随访时间为8天至3.1年。随访中未发现疝复发。并发症包括2例（2.2%）补片感染需要取出补片的患者、1例术后尿潴留患者和另1例血清肿形成患者。
复合聚四氟乙烯/聚丙烯疝修补补片在预防脐疝、上腹疝和小切口疝修补中的疝复发方面有效，且并发症发生率较低。
