Yee J A, Harold K L, Cobb W S, Carbonell A M
Department of General Surgery, Mayo Clinic Arizona, Scottsdale, USA.
Surg Innov. 2008 Dec;15(4):292-6. doi: 10.1177/1553350608325231. Epub 2008 Oct 22.
Laparoscopic ventral hernia repair (LVHR) has gained wide acceptance by both surgeons and patients, but hernias that approach a bony prominence are more complex due to the difficulty of proper fixation. This study was conducted to evaluate the use of bone anchor mesh fixation for complex LVHR.
A prospective study of patients having complex LVHR with bone anchors was conducted using patients from 2 academic institutions between July 2003 and December 2007. Patient demographic data, characteristics of the hernia, operative details, and postoperative outcomes were recorded.
A total of 30 patients who had LVHR using bone anchors were evaluated (20 women, 10 men; mean age 60.9 years, range 41-83 years). In all, 17 suprapubic and 13 lateral hernias were included, requiring a mean of 2.8 and 3.2 bone anchors, respectively. The average hernia defect was 263 cm(2) (range 35-690 cm(2)), and the average mesh size was 663 cm(2) (range 255-1360 cm(2)). Mean operative time was 218 minutes (range 98-420 minutes), with an estimated blood loss of 46 mL (range 10-100 mL). The average length of stay was 5.2 days (range 1-26 days). Seven patients (23.3%) developed postoperative complications, and 1 patient in this study died (mortality 3.3%). During follow-up of 13.2 months (range 1-26 months), 2 patients (6.7%) developed a recurrent hernia.
Bone anchors can be used successfully in the laparoscopic repair of complex ventral hernias, particularly with suprapubic and lateral hernias that approach a bony prominence. The complication rate is acceptable, with a short hospital stay and low recurrence rate.
腹腔镜腹疝修补术（LVHR）已被外科医生和患者广泛接受，但靠近骨性隆起的疝由于难以正确固定而更为复杂。本研究旨在评估骨锚网片固定在复杂LVHR中的应用。
对2003年7月至2007年12月期间来自2个学术机构的接受复杂LVHR并使用骨锚的患者进行前瞻性研究。记录患者的人口统计学数据、疝的特征、手术细节和术后结果。
共评估了30例使用骨锚进行LVHR的患者（20例女性，10例男性；平均年龄60.9岁，范围41 - 83岁）。其中包括17例耻骨上疝和13例侧疝，分别平均需要2.8个和3.2个骨锚。平均疝缺损为263 cm²（范围35 - 690 cm²），平均网片大小为663 cm²（范围255 - 1360 cm²）。平均手术时间为218分钟（范围98 - 420分钟），估计失血量为46 mL（范围10 - 100 mL）。平均住院时间为5.2天（范围1 - 26天）。7例患者（23.3%）发生术后并发症，本研究中有1例患者死亡（死亡率3.3%）。在13.2个月（范围1 - 26个月）的随访中，2例患者（6.7%）出现复发性疝。
骨锚可成功用于复杂腹疝的腹腔镜修补，特别是对于靠近骨性隆起的耻骨上疝和侧疝。并发症发生率可接受，住院时间短且复发率低。
