Uranues Selman, Salehi Behrooz, Bergamaschi Roberto
Department of Surgery, Medical University of Graz, Graz, Austria.
J Am Coll Surg. 2008 Nov;207(5):663-9. doi: 10.1016/j.jamcollsurg.2008.06.330. Epub 2008 Aug 9.
The aim of this study was to determine the impact of laparoscopic adhesiolysis and mesh repair on adverse event rates, quality-of-life (QoL) scores, and recurrence rates in patients with recurrent incisional hernia after failed repairs after multiple laparotomies.
Data on consecutive patients were included prospectively. Recurrent incisional hernia was defined as a fascia defect > 5 cm. Adhesions were classified according to time needed for lysis. A standardized repair with IP polytetrafluoroethylene mesh, transabdominal sutures, and tacks was developed by the surgeons during a pretrial routine. QoL was assessed by the Gastrointestinal Quality of Life Index (GIQLI) before operation and at 24-month followup. Values are median (range).
There were 85 consecutive patients aged 55 years (range 29 to 93 years); 45% were men; body mass index, 31 (range 23 to 39); American Society of Anesthesiologists grade I: 27%, II: 70%, III: 2%; comorbidity, 75%; previous laparotomies; 5 (range 2 to 18); previous colectomy, 87%; previous failed repairs, 4 (range 2 to 15); previous mesh repair, 98%; and midline hernia site, 98%. Fascia defect was 255 cm(2) (range 48 to 416 cm(2)), mesh size, 600 cm(2) (range 285 to 884 cm(2)), and operating time 145 minutes (80 to 210 minutes). There was one conversion. Length of stay was 2 days (1 to 9 days). A 15.2% adverse event rate included 1% port-site cellulitis, 7% seroma, and 7% persistent pain. Hernia recurrence rate was 3.5% at 41-month (range 24 to 61 months) followup. GIQLI total scores were significantly improved at followup (98 versus 116; p < 0.001). Domain GIQLI scores were improved at followup for symptoms (54 versus 63; p < 0.001), emotional function (12 versus 16; p < 0.001), and physical function (15 versus 21; p < 0.001).
Laparoscopic adhesiolysis and recurrent hernia mesh repair resulted in a low rate of adverse events, a substantially improved health-related QoL, and a risk of recurrence similar to the rates associated with first-time hernia repair.
本研究的目的是确定腹腔镜粘连松解术和补片修补术对多次开腹手术修补失败后的复发性切口疝患者不良事件发生率、生活质量（QoL）评分和复发率的影响。
前瞻性纳入连续患者的数据。复发性切口疝定义为筋膜缺损>5 cm。粘连根据松解所需时间进行分类。外科医生在术前常规操作中制定了一种使用IP聚四氟乙烯补片、经腹缝线和钉合器的标准化修补方法。术前和24个月随访时通过胃肠道生活质量指数（GIQLI）评估生活质量。数值为中位数（范围）。
连续85例患者，年龄55岁（范围29至93岁）；45%为男性；体重指数为31（范围23至39）；美国麻醉医师协会分级I级：27%，II级：70%，III级：2%；合并症发生率为75%；既往开腹手术次数为5次（范围2至18次）；既往结肠切除术发生率为87%；既往修补失败次数为4次（范围2至15次）；既往补片修补率为98%；中线疝部位发生率为98%。筋膜缺损面积为255 cm²（范围48至416 cm²），补片大小为600 cm²（范围285至884 cm²），手术时间为145分钟（80至210分钟）。有1例中转开腹。住院时间为2天（1至9天）。不良事件发生率为15.2%，包括1%的切口部位蜂窝织炎、7%的血清肿和7%的持续性疼痛。在41个月（范围24至61个月）随访时疝复发率为3.5%。随访时GIQLI总分显著改善（98对116；p<0.001）。随访时GIQLI各领域评分在症状（54对63；p<0.001）、情绪功能（12对16；p<0.001）和身体功能（15对21；p<0.001）方面均有所改善。
腹腔镜粘连松解术和复发性疝补片修补术导致不良事件发生率低，与健康相关的生活质量显著改善，复发风险与首次疝修补术相关的发生率相似。
