Baccari Paolo, Nifosi Jacopo, Ghirardelli Luca, Staudacher Carlo
Department of General Surgery, Division of Gastrointestinal Surgery, Scientific Institute San Raffaele University Hospital, Milan, Italy.
J Laparoendosc Adv Surg Tech A. 2009 Apr;19(2):175-9. doi: 10.1089/lap.2008.0244.
Laparoscopic incisional and ventral herniorraphy (LIVH), using a mesh, has gained recognition as an effective method and is associated with lower complication and recurrence. Controversies in the operative technique still exist about biomaterial, method of fixation, and overlap of the mesh over the defect. The aim of this study was to evaluate the outcomes achieved with LIVH in 200 consecutive patients treated in a single hospital, using fixation of the mesh with only tacks. Results of the first 100 (group A) and the last 100 (group B) operations were also compared.
From 2003 through 2007, 200 patients underwent LIVH. Overlap of the mesh was 3-5 cm. The mesh was secured with tacks alone, with the "double crown" technique. In group B, adhesiolysis was performed, avoiding high energies.
Mean ventral defect was 107.5 (+/- 95.4) cm2. The recurrent ventral hernia rate was 20%, and the conversion rate was 2.5%. Mean operative time was 77.5 (+/- 33.9) minutes. Mean mesh dimension was 326.4 (+/- 166.8) cm2. The overall morbidity rate was 10.5%. Bowel injuries were 5 (2.5 %). Minor complications were 8.0%. Median postoperative hospital stay was 3 days. Recurrence rate was 3.5%, with a mean follow-up of 22.5 months. Chronic pain was 1%. No difference was seen between groups A and B regarding minor complications, whereas a significant difference was found regarding enterotomies (5 vs. 0; P = 0.024) and recurrences (6 vs. 1; P = 0.056).
Fixation of the mesh with the sole use of tacks was demonstrated to be safe and effective. Avoiding high energies, no case of enterotomy occurred.
使用补片的腹腔镜切口疝和腹疝修补术（LIVH）已被公认为一种有效的方法，且并发症和复发率较低。在手术技术方面，关于生物材料、固定方法以及补片在缺损处的重叠仍存在争议。本研究的目的是评估在一家医院接受治疗的200例连续患者采用仅用钉合固定补片的LIVH手术的效果。同时还比较了前100例手术（A组）和后100例手术（B组）的结果。
2003年至2007年期间，200例患者接受了LIVH手术。补片重叠3 - 5厘米。采用“双冠”技术仅用钉合固定补片。在B组中，进行粘连松解时避免使用高能量。
平均腹侧缺损为107.5（±95.4）平方厘米。腹侧复发疝发生率为20%，中转开腹率为2.5%。平均手术时间为77.5（±33.9）分钟。平均补片尺寸为326.4（±166.8）平方厘米。总发病率为10.5%。肠损伤5例（2.5%）。轻微并发症发生率为8.0%。术后中位住院时间为3天。复发率为3.5%，平均随访22.5个月。慢性疼痛发生率为1%。A组和B组在轻微并发症方面无差异，而在肠切开术（5例 vs. 0例；P = 0.024）和复发率（6例 vs. 1例；P = 0.056）方面存在显著差异。
仅用钉合固定补片被证明是安全有效的。避免使用高能量，未发生肠切开术病例。
