Kukleta Jan F
Klinik Im Park, Zurich, Switzerland.
J Minim Access Surg. 2006 Sep;2(3):187-91. doi: 10.4103/0972-9941.27736.
The analysis of possible mechanisms of repair failure is a necessary instrument and the best way to decrease the recurrence rate and improve the overall results. Avoiding historical errors and learning from the reported pitfalls and mistakes helps to standardize the relatively new laparoscopic techniques of trans-abdominal preperitoneal and total extraperitoneal.
The video tapes of all primary laparoscopic repairs done by the author that led to recurrence were retrospectively analyzed and compared with findings at the second laparoscopic repair. A review of the available cases of recurrences occurring between 1994 and 2003 is the basis of this report.
Adequate mesh size, porosity of mesh material, slitting of the mesh, correct and generous dissection of preperitoneal space and wrinkle-free placement of the mesh seem to be the more important factors in avoiding recurrence rather than strength of the material or strong penetrating fixation. Special attention should be paid to preperitoneal lipoma as a possible overlooked herniation or potential future pseudorecurrence despite nondislocated correctly positioned mesh.
Laparoscopic hernia repair is a complex but very efficient method in experienced hands. To achieve the best possible results, it requires an acceptance of a longer learning curve, structured well-mentored training and high level of standardization of the operative procedure.
分析修复失败的可能机制是降低复发率和改善总体效果的必要手段及最佳方法。避免历史错误并从已报道的陷阱和失误中吸取教训，有助于规范相对较新的经腹腹膜前和完全腹膜外腹腔镜技术。
对作者进行的所有导致复发的初次腹腔镜修复手术录像进行回顾性分析，并与二次腹腔镜修复时的发现进行比较。本报告以1994年至2003年间发生的复发病例回顾为基础。
合适的补片尺寸、补片材料的孔隙率、补片切开、正确且充分的腹膜前间隙分离以及补片无褶皱放置，似乎是避免复发的更重要因素，而非材料强度或强力穿透固定。应特别注意腹膜前脂肪瘤，它可能是被忽视的疝出或尽管补片位置正确未移位但未来可能出现假复发的潜在因素。
腹腔镜疝修补术在经验丰富的医生手中是一种复杂但非常有效的方法。为获得最佳效果，需要接受较长的学习曲线、结构化的良好指导培训以及高水平的手术操作标准化。
