Department of Surgery and Interventional Science, University College London, 4th Floor, Medical School Building, 74 Huntley Street, London WC1E 6AU, UK.
Int J Surg. 2010;8(6):470-3. doi: 10.1016/j.ijsu.2010.06.008. Epub 2010 Jul 23.
In published series with satisfactory follow-up incisional hernia rates following laparotomy vary between 4 and 18%, with up to 75% developing within two years of operation. This therefore represents the commonest complication following open abdominal surgery and a substantial added workload for the colorectal/general surgeon.
To prospectively review incisional hernia rates in patients undergoing laparoscopic colorectal resection in a single centre.
All laparoscopic wounds were closed in identical fashion to open closure technique, utilising 0-monofilament, polyglyconate and a mass closure technique, followed by a subcuticular, polyglactin-910 suture for skin closure. All patients were subsequently examined in an outpatient setting by a senior surgeon independent to the original procedure.
167 consecutive patients undergoing laparoscopic colorectal resections (94M:73F; median age 68 years) were included. Median incision length for specimen extraction was 6 cm (range 3-11 cm) and patients were followed-up for a median of 36 months (range 24-77 months). Twelve (7%) patients developed an incisional hernia (ten in specimen extraction wounds and two in port-site wounds), ten of whom underwent successful laparoscopic repairs. Of the remaining patients, one remains symptomatic and awaits repair, and one is asymptomatic and unfit for surgery.
The well-documented advantages of laparoscopic surgery include reduced hospital stay, early return to activity, decreased analgesic requirements and improved cosmesis. However, the results of this study suggest that incisional hernia rates are not decreased by laparoscopic surgery, although the hernias may be smaller and more amenable to repair by laparoscopic approaches.
在发表的系列研究中，剖腹手术后的切口疝发生率在 4%至 18%之间，有高达 75%的切口疝在手术后两年内发生。因此，这是开放腹部手术后最常见的并发症，也是结直肠/普通外科医生的一项重要额外工作。
前瞻性地回顾单中心行腹腔镜结直肠切除术患者的切口疝发生率。
所有腹腔镜切口均采用与开放切口相同的闭合技术进行闭合，使用 0 单丝、聚甘醇酸和质量闭合技术，然后使用皮下聚乳酸-910 缝线进行皮肤闭合。所有患者随后由与原始手术无关的资深外科医生在门诊进行检查。
共纳入 167 例连续行腹腔镜结直肠切除术的患者（94 例男性：73 例女性；中位年龄 68 岁）。标本取出的切口长度中位数为 6 厘米（范围 3-11 厘米），患者中位随访时间为 36 个月（范围 24-77 个月）。12 例（7%）患者发生切口疝（10 例发生在标本取出切口，2 例发生在端口部位切口），其中 10 例成功进行了腹腔镜修复。其余患者中，1 例仍有症状且需要修复，1 例无症状但不适合手术。
腹腔镜手术的优势已得到充分证实，包括住院时间缩短、早期恢复活动、减少镇痛需求和改善美容效果。然而，本研究结果表明，腹腔镜手术并不能降低切口疝的发生率，尽管疝可能较小，更适合通过腹腔镜方法进行修复。
