General Surgical Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Int J Surg. 2012;10(3):153-6. doi: 10.1016/j.ijsu.2012.02.004. Epub 2012 Feb 16.
Prosthetic mesh reduces the risk of hernia recurrence. The use of mesh in patients with strangulated hernias requiring bowel resection is controversial.
Patients with acutely incarcerated hernias (with small intestine contents) who underwent polypropylene mesh hernioplasty were included in this prospective study from June 2005 to Jan. 2011.
163 patients were included; 48 required intestinal resection and anastomosis (Group I) and 115 did not (Group II). Operative times and hospital stay were longer in Group I (P = 0.001). No significant difference was noted between both groups in terms of postoperative morbidities (16.6% vs 13% P = 0.5), wound infection (6% vs 4% P = 0.6), and recurrence rate (2% vs 2.8% P = 0.8), All cases of wound infection were successfully managed with drainage and local wound care and no mesh had to be removed. One patient in Group I and five patients in Group II died of concomitant diseases in the follow-up period (P = 0.5).
Mesh hernioplasty is crucial to prevent recurrence, and it is safe to utilize it in repair of acutely incarcerated hernias even if associated with intestinal resection.
修补网片可降低疝复发的风险。在需要肠切除吻合术的绞窄性疝患者中使用网片存在争议。
本前瞻性研究纳入了 2005 年 6 月至 2011 年 1 月间患有急性嵌顿疝(小肠内容物)并接受聚丙烯网片修补术的患者。
共纳入 163 例患者,其中 48 例需要肠切除和吻合术(I 组),115 例不需要(II 组)。I 组的手术时间和住院时间较长(P=0.001)。两组术后并发症(16.6% vs 13%,P=0.5)、伤口感染(6% vs 4%,P=0.6)和复发率(2% vs 2.8%,P=0.8)无显著差异。所有伤口感染病例均通过引流和局部伤口护理成功治疗,无需取出网片。I 组 1 例和 II 组 5 例患者在随访期间死于合并症(P=0.5)。
网片修补术对于预防复发至关重要,即使与肠切除相关,在修复急性嵌顿疝时使用它也是安全的。