Department of General Surgery, Urgency, and Organ Transplantation, University of Palermo, Palermo, Italy.
Hernia. 2011 Dec;15(6):659-65. doi: 10.1007/s10029-011-0842-9. Epub 2011 Jul 8.
Issues in ventral hernia repair are represented by the need for mesh fixation and how to assure a sufficient mesh overlap of the defect. Aiming to resolve these problems, this study describes a modified technique for ventral and incisional hernia repair based upon a newly developed mesh with a special design. This new type of implant allows broader coverage of the abdominal wall and results in tension- and fixation-free repair.
A unique geometrically shaped mesh consisting of a large central body and radiating arms was used to repair ventral or incisional hernia. The mesh was intended not to be point-fixated. The friction of the straps passing through the tissues was hypothesized to be adequate to maintain the mesh firmly fastened in the abdominal wall, ensuring a wide coverage far from the hernia border. The newly designed mesh was placed in the preperitoneal sublay in 22 patients with ventral or incisional hernia. All straps were passed laterally through the transverse and oblique muscles. In all patients, a defect overlap of at least 8-12 cm was achieved.
In a midterm follow-up of 18-24 (mean 22) months, three seromas and one infection occurred, which were successfully managed without mesh removal. No hematoma, chronic pain, or recurrence has been reported to date.
The described arm system of the implant allowed for a much smaller incision and eliminated the complicated maneuvers associated with suturing the mesh. The fixation arms seemed to have ensured the mesh stayed orientated in all patients. A very wide lateral mesh placement was accomplished, assuring sufficient defect overlap when shrinkage occurs.
腹疝修补术的问题表现为需要对补片进行固定以及如何确保缺陷有足够的补片重叠。为了解决这些问题，本研究描述了一种基于新开发的具有特殊设计的补片的改良技术，用于腹疝和切口疝修补。这种新型植入物允许更广泛地覆盖腹壁，并实现无张力和无固定修复。
使用一种独特的几何形状的补片，由一个大的中央体和辐射臂组成，用于修复腹疝或切口疝。该补片的目的不是点状固定。假设通过组织穿过的带子的摩擦力足以将补片牢固地固定在腹壁上，确保在远离疝边界的宽范围内覆盖。将新设计的补片放置在 22 例腹疝或切口疝患者的腹膜前下区。所有的带子都从横向穿过横肌和斜肌。在所有患者中，均实现了至少 8-12cm 的缺损重叠。
在 18-24 个月的中期随访中（平均 22 个月），发生了 3 例血清肿和 1 例感染，均成功地在不取出补片的情况下进行了治疗。迄今为止，没有报告血肿、慢性疼痛或复发。
所描述的植入物臂系统允许更小的切口，并消除了与缝合补片相关的复杂操作。固定臂似乎确保了在所有患者中补片保持定向。完成了非常宽的侧向补片放置，确保在发生收缩时有足够的缺损重叠。
