Dur A H M, den Hartog D, Tuinebreijer W E, Kreis R W, Lange J F
Department of Surgery, Red Cross Hospital, Vondellaan 13, Beverwijk 1942 LE, The Netherlands.
Hernia. 2009 Aug;13(4):421-6. doi: 10.1007/s10029-009-0487-0. Epub 2009 Mar 19.
Incisional hernia is a serious complication after abdominal surgery and occurs in 11-23% of laparotomies. Repair can be done, for instance, with a direct suture technique, but recurrence rates are high. Recent literature advises the use of mesh repair. In contrast to this development, we studied the use of a direct suture repair in a separate layer technique. The objective of this retrospective observational study is to assess the outcomes (recurrences and complications) of a two-layered open closure repair for primary and recurrent midline incisional hernia without the use of mesh.
In an observational retrospective cohort study, we analysed the hospital and outpatient records of 77 consecutive patients who underwent surgery for a primary or recurrent incisional hernia between 1st May 2002 and 8th November 2006. The repair consisted of separate continuous suturing of the anterior and posterior fascia, including the rectus muscle, after extensive intra-abdominal adhesiolysis.
Forty-one men (53.2%) and 36 women (46.8%) underwent surgery. Sixty-three operations (81.8%) were primary repairs and 14 (18.2%) were repairs for a recurrent incisional hernia. Of the 66 patients, on physical examination, three had a recurrence (4.5%) after an average follow-up of 2.6 years. The 30-day postoperative mortality was 1.1%. Wound infection was seen in five patients (6.5%).
A two-layered suture repair for primary and recurrent incisional hernia repair without mesh with extensive adhesiolysis was associated with a recurrence rate comparable to mesh repair and had an acceptable complication rate.
切口疝是腹部手术后的一种严重并发症，在剖腹手术患者中发生率为11%-23%。例如，可以采用直接缝合技术进行修复，但复发率较高。近期文献建议使用补片修补术。与这一发展趋势相反，我们研究了在单独层次技术中使用直接缝合修复的方法。这项回顾性观察性研究的目的是评估在不使用补片的情况下，两层开放式缝合修复原发性和复发性中线切口疝的疗效（复发率和并发症）。
在一项观察性回顾性队列研究中，我们分析了2002年5月1日至2006年11月8日期间连续接受原发性或复发性切口疝手术的77例患者的住院和门诊记录。修复方法包括在广泛的腹腔内粘连松解术后，对包括腹直肌在内的前、后筋膜进行单独连续缝合。
41名男性（53.2%）和36名女性（46.8%）接受了手术。63例手术（81.8%）为初次修复，14例（18.2%）为复发性切口疝修复。在66例患者中，体格检查发现，平均随访2.6年后，3例复发（4.5%）。术后30天死亡率为1.1%。5例患者（6.5%）出现伤口感染。
在不使用补片且进行广泛粘连松解的情况下，两层缝合修复原发性和复发性切口疝，其复发率与补片修补术相当，并发症发生率可接受。
