Northwestern University, Chicago, IL 60611, USA.
Am J Surg. 2010 Aug;200(2):258-64. doi: 10.1016/j.amjsurg.2009.08.040. Epub 2010 Feb 1.
Hernia patients with a history of recurrent bowel obstructions, chronic bowel dysmotility, and bowel distension have few options for return to a "normal" life. Return of the bowel and adhesiolysis seems the logical surgical solution, but the return of a swollen distended bowel into the abdominal cavity would put patients at a high risk for the development of abdominal compartment syndrome. Hernia repair with large pieces of mesh under tenuous skin flaps to incorporate the bowel into the abdominal cavity has its own set of devastating complications, including mesh infection, extrusion, and fistula formation.
Here we present 4 patients who underwent successful treatment with a combined small bowel resection for volume reduction and simultaneous components separation hernia repair for autogenous closure without mesh.
All patients had successful abdominal wall closure without major complications and were tolerating enteral feedings upon discharge.
A combined approach of small bowel resection and separation of parts hernia repair is a feasible and successful means for approaching challenging abdominal wall defects with chronically distended bowel. A vicious cycle in which postoperative elevation in intra-abdominal pressure leads to severe systemic consequences can be averted. Moreover, bowel function can be restored and excellent cosmesis achieved, leading to significant improvements in patients' quality of life.
有反复肠阻塞、慢性肠动力障碍和肠扩张病史的疝患者几乎没有恢复“正常”生活的选择。肠还纳和粘连松解似乎是合乎逻辑的手术解决方案，但肿胀扩张的肠段回到腹腔会使患者发生腹腔间隔室综合征的风险很高。在脆弱的皮瓣下使用大块网片进行疝修补，将肠纳入腹腔，会带来一系列严重的并发症，包括网片感染、脱出和瘘管形成。
在这里，我们介绍了 4 名患者，他们接受了联合小肠切除术（用于体积缩小）和同时进行的组件分离疝修补术（用于自体闭合而无需使用网片），取得了成功的治疗效果。
所有患者均成功关闭腹壁，无重大并发症，出院时均能耐受肠内喂养。
对于慢性扩张肠段的复杂腹壁缺损，联合小肠切除术和分离部分疝修补术是一种可行且成功的方法。可以避免术后腹内压升高导致严重全身后果的恶性循环。此外，肠功能可以恢复，并且可以获得出色的美容效果，从而显著提高患者的生活质量。
