Department of Surgery, Kaunas University of Medicine, Eiveniu str. 2, 50009, Kaunas, Lithuania.
Hernia. 2010 Dec;14(6):575-82. doi: 10.1007/s10029-010-0686-8. Epub 2010 Jun 22.
The incidence of incisional hernia after midline laparotomies ranges from 10 to 20%. The recurrence rate after this hernia surgery varies from 25 to 52% using autogenous tissue. The use of prosthetic meshes can decrease the postoperative hernia recurrence by up to 10%. The aim of this prospective randomized clinical study was to analyze and compare the results of three different incisional hernia surgical techniques.
One hundred and sixty-one patients who underwent incisional hernia surgery were randomized into three groups. The Keel technique was used in the first group, the "Onlay" technique (prosthetic mesh is fixed on the external abdominal muscle slip) in the second group, and the "Sublay" technique (prosthetic mesh is placed on the posterior abdominal muscle sheath) in the third group. Age, sex, hospitalization time, body mass index (BMI), intraabdominal pressure, postoperative complications, postoperative pain, normal physical activity recovery time, and recurrence rate were compared between the groups. The postoperative follow-up period was 12 months.
Fifty-four patients in the Keel group, 57 patients in the "Onlay" group, and 50 patients in the "Sublay" group were operated. Age, hospitalization time, and BMI were similar in all of the groups. The operative time was significantly longer in the prosthetic mesh groups compared with the Keel group. The intraabdominal pressure changes before and after surgery was significantly higher in the Keel group compared with the prosthetic mesh groups (5.66 ± 2.5 mmHg vs. 1.88 ± 1 mmHg vs. 1.76 ± 1 mmHg; P < 0.05). The postoperative wound complications rate was significantly higher in the "Onlay" technique group compared with the Keel and "Sublay" technique groups (49.1% vs. 22.2% vs. 24%; P < 0.05). Postoperative pain (VAS score) was significantly lower in the "Onlay" and "Sublay" groups (5.53 ± 1.59 vs. 3.96 ± 1.56 vs. 3.78 ± 1.97; P < 0.05). All of the patients in "Sublay" group recovered to normal physical activity during the 6 months follow-up period compared with 94.4% of patients in the Keel group and 98.3% of patients in the "Onlay" group. The recurrence rate was 22.2% in the Keel group, 10.5% in the "Onlay" group, and 2% in the "Sublay" group during the follow-up period. The general complications rate after hernia surgery was 5.6%. Postoperative pneumonia was the most frequent complication, which appeared in 4.3% of patients. There was no postoperative death in our prospective study.
Mesh repair is the first-choice technique for incisional hernia treatment. The results of the "Sublay" technique are better than the "Onlay" technique.
经腹正中切开术后切口疝的发病率为 10%至 20%。 这种疝手术后的复发率使用自体组织为 25%至 52%。 使用假体网片可将术后疝复发率降低 10%。 本前瞻性随机临床试验的目的是分析和比较三种不同切口疝手术技术的结果。
161 名接受切口疝手术的患者被随机分为三组。 第一组采用龙骨技术，第二组采用“Onlay”技术（假体网片固定在腹壁外肌滑车上），第三组采用“Sublay”技术（假体网片置于后腹壁肌鞘上）。 比较组间年龄、性别、住院时间、体重指数（BMI）、腹腔内压、术后并发症、术后疼痛、正常体力活动恢复时间和复发率。 术后随访 12 个月。
龙骨组 54 例，“Onlay”组 57 例，“Sublay”组 50 例。 所有组的年龄、住院时间和 BMI 相似。 与龙骨组相比，假体网片组的手术时间明显延长。 与假体网片组相比，龙骨组术前和术后的腹腔内压变化明显更高（5.66±2.5mmHg 比 1.88±1mmHg 比 1.76±1mmHg；P<0.05）。 “Onlay”技术组的术后伤口并发症发生率明显高于龙骨组和“Sublay”技术组（49.1%比 22.2%比 24%；P<0.05）。 “Onlay”和“Sublay”组术后疼痛（VAS 评分）明显低于龙骨组（5.53±1.59 比 3.96±1.56 比 3.78±1.97；P<0.05）。 与龙骨组 94.4%和“Onlay”组 98.3%的患者相比，“Sublay”组所有患者在 6 个月随访期间均恢复正常体力活动。 随访期间，龙骨组复发率为 22.2%，“Onlay”组为 10.5%，“Sublay”组为 2%。 疝手术后的总并发症发生率为 5.6%。 术后肺炎是最常见的并发症，发生率为 4.3%。 在我们的前瞻性研究中，没有术后死亡病例。
网片修复是切口疝治疗的首选技术。 “Sublay”技术的结果优于“Onlay”技术。
