Forte Angelo, Zullino Antonio, Manfredelli Simone, Montalto Gioacchino, Covotta Francesco, Pastore Piergiorgio, Bezzi Marcello
IV Scuola di Specializzazione in Chirurgia Generale, Department of Surgery "F. Durante", Sapienza University, Rome, Italy.
Ann Ital Chir. 2011 Jul-Aug;82(4):313-7.
We report our clinical experience with incisional hernia surgery and we retrospectively analyze the outcomes obtained with the different techniques of repair used, confirming that Rives-Stoppa procedures actually represent the gold standard for incisional hernia.
334 patients were observed for incisional hernioplasty at our Department of Surgery from 1996 to 2007. They were treated according to the following surgical procedures: 44 primary direct closures; 246 Rives-Stoppa procedures; 9 Chevrel procedures; 35 intraperitoneal repairs. The outcomes were considered in terms of postoperative surgical complications.
In total, we had 13 cases of hernia recurrence (3.9%), 14 cases of infections (4.2%), 7 cases ofseroma/hematoma (2.9%) and one case of acute respiratory insufficiency.
The choice of the surgical technique depends on several factors, such as the size of the hernia defect and the representation of the anatomical structures, essential for the reconstruction of the abdominal wall. We abandoned Chevrel technique due to high rate of recurrence and infective complications and reserved the intra-peritoneal repair only for cases where a fascial layer could not be reconstructed. Instead, the primary direct closure should be considered for high risk patients because of its low surgical impact, although it is characterized by higher incidence of recurrence. Combining the Rives-Stoppa technique with some personal technical modifications, we obtained acceptable results in terms of recurrence rate and morbidity.
Rives-Stoppa procedures are the current standard of care for the surgical repair of incisional hernia and our treatment of choice.
我们报告切口疝手术的临床经验，并回顾性分析所采用的不同修复技术的效果，证实里夫斯 - 斯托帕手术实际上是切口疝治疗的金标准。
1996年至2007年期间，我们外科对334例患者进行了切口疝修补术观察。他们接受了以下手术治疗：44例一期直接缝合；246例里夫斯 - 斯托帕手术；9例谢弗雷尔手术；35例腹膜内修补术。根据术后手术并发症来评估治疗效果。
总共出现13例疝复发（3.9%）、14例感染（4.2%）、7例血清肿/血肿（2.9%）以及1例急性呼吸功能不全。
手术技术的选择取决于几个因素，如疝缺损的大小以及腹壁重建所需解剖结构的表现。由于复发率和感染并发症发生率高，我们放弃了谢弗雷尔技术，仅在无法重建筋膜层的病例中保留腹膜内修补术。相反，由于对手术影响小，一期直接缝合应考虑用于高危患者，尽管其复发率较高。通过对里夫斯 - 斯托帕技术进行一些个人技术改良，我们在复发率和发病率方面取得了可接受的结果。
里夫斯 - 斯托帕手术是目前切口疝手术修复的标准治疗方法，也是我们的首选治疗方式。
