Maman Daniel, Greenwald Daniel, Kreniske Jonah, Royston Aaron, Powers Sarah, Bauer Joel
Department of Surgery, Mount Sinai School of Medicine, New York, NY 10021, USA.
Ann Plast Surg. 2012 Feb;68(2):190-3. doi: 10.1097/SAP.0b013e318212f380.
Incisional hernias develop in 2% to 11% of patients who undergo laparotomy. Prosthetic mesh repair provides more strength, tension-free closure, and decreased recurrence rates as compared to primary tissue repairs. Complications-fistula formation, adhesions, skin erosion, and seroma/abscess formation-however, include increased rates of infection, sometimes requiring complete mesh removal. The Rives-Stoppa repair for complex incisional hernias confers the benefits of prosthetic repair and lower recurrence rates, but decreases certain complications by preventing direct mesh contact with the bowel. A total of 89 consecutive patients (mean age, 58.1) underwent a modified Rives-Stoppa repair for purposes of this review, all the patients who lost to follow-up before 6 months postoperatively were excluded from the study. Of the remaining 59 patients, 32.2% (n = 19) had expanded polytetrafluoroethylene mesh, and 67.8% (n = 40) had polypropylene mesh. Average range of follow-up was 40.0 months. Hernia recurred in 1 patient (1.7%). Infection requiring explantation of the prosthesis occurred in 3 patients (5.1%). The Rives-Stoppa repair is reportedly the best open technique for complex incisional hernias with comparatively lower recurrence rates. Additionally, patients with inflammatory bowel disease (64.4% of our series), who often require later reoperation for their primary disease, may benefit from this technique of herniorrhaphy where no interface exists between intrabdominal contents and the prosthesis. This lack of interface decreases intrabdominal adhesions and facilitates re-entry if future surgery is needed for inflammatory bowel disease.
剖腹手术患者中2%至11%会发生切口疝。与原发性组织修复相比，人工补片修复提供了更强的强度、无张力闭合，并降低了复发率。然而，并发症——瘘管形成、粘连、皮肤侵蚀和血清肿/脓肿形成——包括感染率增加，有时需要完全移除补片。针对复杂切口疝的里夫斯-斯托帕修复术具有人工修复的优点且复发率较低，但通过防止补片与肠道直接接触降低了某些并发症的发生率。为了本综述，共有89例连续患者（平均年龄58.1岁）接受了改良的里夫斯-斯托帕修复术，所有术后6个月前失访的患者均被排除在研究之外。在其余59例患者中，32.2%（n = 19）使用了膨化聚四氟乙烯补片，67.8%（n = 40）使用了聚丙烯补片。平均随访时间为40.0个月。1例患者（1.7%）疝复发。3例患者（5.1%）发生了需要取出假体的感染。据报道，里夫斯-斯托帕修复术是治疗复杂切口疝的最佳开放技术，复发率相对较低。此外，炎症性肠病患者（占我们系列病例的64.4%），他们经常需要因原发性疾病进行再次手术，可以从这种疝修补技术中获益，因为腹腔内容物与假体之间不存在界面。这种无界面情况减少了腹腔内粘连，并在未来因炎症性肠病需要手术时便于再次进入腹腔。
