Seiler C M, Diener M K
Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg.
Chirurg. 2010 Mar;81(3):186-91. doi: 10.1007/s00104-009-1816-7.
Incisional hernias are the most common long-term complication after laparotomy with a cumulative incidence up to 20%. Generally all injuries to the integrity of the abdominal wall can result in the development of an incisional hernia. Midline and transverse incisions cause similar hernia rates. By selection of a sufficient closure technique and appropriate suture material as well as taking appropriate accompanying treatment (antibiotic prophylaxis) and risk factors into consideration, surgery can reduce surgical site infections, wound dehiscence and incisional hernias. Results from randomized controlled trials have not yet demonstrated a superiority of laparoscope-assisted procedures compared to laparotomy for the prevention of incisional hernias. Access through natural orifices and removal of specimens through the same approach (NOTES) may prevent incisional hernias completely. The approach to the abdominal cavity has to be chosen according to the underlying disease of the patient, the anatomical conditions and further circumstances (e.g. urgency, extensibility, preservation of function of the abdominal wall and safety).
切口疝是剖腹手术后最常见的长期并发症，累积发生率高达20%。一般来说，腹壁完整性的所有损伤都可能导致切口疝的发生。中线切口和横切口导致的疝发生率相似。通过选择足够的闭合技术和合适的缝合材料，以及考虑适当的伴随治疗（抗生素预防）和风险因素，手术可以减少手术部位感染、伤口裂开和切口疝。随机对照试验的结果尚未证明腹腔镜辅助手术在预防切口疝方面优于剖腹手术。通过自然腔道进入并通过相同途径取出标本（NOTES）可能完全预防切口疝。必须根据患者的基础疾病、解剖条件和其他情况（如紧迫性、可扩展性、腹壁功能的保留和安全性）来选择进入腹腔的方法。
