Centre Hospitalier Universitaire de Tivoli, Avenue Max Buset 34, 7100, La Louvière, Belgium.
Hernia. 2010 Apr;14(2):123-9. doi: 10.1007/s10029-010-0637-4. Epub 2010 Feb 14.
This report reviews the clinical and functional outcomes of implanted meshes during a second-look evaluation of 85 cases after a large number (733) of laparoscopic incisional and ventral hernia repairs (LIVHR), of which 608 were controlled throughout a period of 5 to 10 years. This report demonstrates a minimal occurrence of adhesions and a low rate of recurrences and other complications related to mesh usage.
Eighty-five re-operated cases after LIVHR were reviewed retrospectively. In every redo surgery, the first trocar was always inserted on a lateral side, external to the previous skin incisions of the transabdominal fixations. Mueller's adhesion scale was used to estimate adhesion severity (Mueller 0 indicates no adhesion; Mueller I indicates adhesion of the omentum; and Mueller II indicates serosal adhesions). The mechanism of recurrence is of paramount interest and is analyzed herein. If recurrence was observed, the defect was closed and a larger mesh of Parietex was implanted under the previous one, with transparietal fixation achieved by pulling the threads with the Endoclose device.
In all of our "second-look" surgeries, the neoperitoneum perfectly covered the mesh. In 47.05% of the cases, we observed no adhesions (Mueller 0), 42.3% had adhesions of the omentum (Mueller I), and 10.58% had serosal adhesions (Mueller II). There was no shrinking or wrinkling of the prosthesis in any of the cases, confirming its total peritonization on the anterior abdominal wall. Within the first 3 years, only 4.1% of the controlled patients contracted recurrences, with a mean follow-up of 52 months.
With the double-suturing technique used for LIVHR and the use of a composite mesh, we observed a low rate of recurrences and limited side effects as compared with the use of tacks intra-abdominally. Redo surgeries after LIVHR are feasible, but care must be taken due to unpredictable mesh adhesions.
本报告回顾了 85 例大量（733 例）腹腔镜切口和腹侧疝修补术（LIVHR）后二次探查评估中植入网片的临床和功能结果，其中 608 例在 5 至 10 年的时间内得到了控制。本报告显示网片使用相关的粘连发生率低，复发率和其他并发症发生率低。
回顾性分析 85 例 LIVHR 后再次手术的病例。在每次再次手术中，第一套管针总是插入在外侧，位于先前经腹固定的皮肤切口之外。使用 Mueller 粘连量表评估粘连严重程度（Mueller 0 表示无粘连；Mueller I 表示大网膜粘连；Mueller II 表示浆膜粘连）。复发的机制是至关重要的，在此进行分析。如果观察到复发，通过将缝线用 Endoclose 装置牵拉来关闭缺损，并在先前的网片下植入更大的 Parietex 网片，进行经皮固定。
在我们所有的“二次探查”手术中，新腹膜完美地覆盖了网片。在 47.05%的病例中，我们观察到无粘连（Mueller 0），42.3%的病例有大网膜粘连（Mueller I），10.58%的病例有浆膜粘连（Mueller II）。在任何情况下都没有假体的收缩或起皱，这证实了它在前腹壁上完全腹膜化。在最初的 3 年内，只有 4.1%的受控制患者出现复发，平均随访时间为 52 个月。
与腹腔内使用钉枪相比，我们使用 LIVHR 的双缝合技术和复合网片，观察到复发率较低，副作用有限。LIVHR 后再次手术是可行的，但由于网片粘连不可预测，需要谨慎操作。
