Department of Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan.
Surg Today. 2012 Apr;42(4):359-62. doi: 10.1007/s00595-011-0019-2. Epub 2011 Nov 10.
No consensus has been reached on the use of prostheses in a potentially infected operating field. In this study, we evaluated the validity of a mesh prosthesis for the repair of incarcerated groin hernias with intestinal resection.
Twenty-seven patients underwent operations for correction of incarcerated groin hernias with small intestinal resection at our hospital between January 2000 and March 2010. The patients were divided into two groups: those who underwent repair with a prosthetic mesh and those who underwent primary hernia repair. Patients with intestinal perforations, abscess formations, panperitonitis, and those who required colon resections were excluded. The length of the operation, blood loss, and incidences of surgical site infection, postoperative ileus, and recurrence were evaluated in each group.
Of the 27 patients studied, 10 (37%) underwent tension-free repair with a mesh, and 17 (63%) underwent primary hernia repair. Although the patients who underwent primary hernia repair were significantly older than the patients who underwent mesh repair (P = 0.015), no statistically significant differences in morbidity, including surgical site infection, or mortality, were identified.
Strangulated inguinal hernias cannot be considered a contraindication to the use of a prosthetic mesh even in cases requiring small-intestinal resection.
在潜在感染的手术区域中使用假体尚未达成共识。本研究评估了网片在修复伴有肠切除的嵌顿性腹股沟疝中的有效性。
2000 年 1 月至 2010 年 3 月期间,我院对 27 例伴有小肠切除的嵌顿性腹股沟疝患者进行了手术治疗。将患者分为两组:一组采用假体网片修补,另一组采用原发性疝修补。排除肠穿孔、脓肿形成、全腹膜炎以及需要结肠切除术的患者。评估每组患者的手术时间、失血量以及手术部位感染、术后肠梗阻和复发的发生率。
在 27 例患者中,10 例(37%)采用无张力网片修补,17 例(63%)采用原发性疝修补。虽然原发性疝修补组患者的年龄明显大于网片修补组(P=0.015),但两组患者在发病率(包括手术部位感染)或死亡率方面无统计学差异。
即使需要小肠切除,绞窄性腹股沟疝也不能被视为使用假体的禁忌证。