Department of Digestive Surgery, University Hospital, University of Picardy, Amiens, France.
Hernia. 2012 Aug;16(4):445-9. doi: 10.1007/s10029-012-0931-4. Epub 2012 Jun 12.
Open tension-free hernioplasty using prosthetic meshes dramatically reduced recurrence rates after hernia or incisional hernia repair and has become the rule. Mesh infections (MI) are the major complication of prosthetic material. The aim of this study was to assess the efficacy of partial removal of mesh (PRM) therapy in the treatment of MI.
From January 2000 to April 2010, from a prospective database, we retrospectively selected patients who underwent surgery for MI. We studied the epidemiological data (sex, age, obesity, diabetes, smoking), the operating time of the initial intervention, the presence of intestinal injuries during the first intervention, the average interval between initial surgical procedure and MI, the location of the hernia, the average size of the hernia, type of mesh used, the position of the mesh, type of surgery performed, the number through interventions required to achieve a cure, the cumulative duration of hospital stay and hernia recurrence rates.
Twenty-five patients were supported for a MI in our institution. There were 9 women (36 %) and 16 men (64 %). The median age was 59 years (range 37-78). There were 4 inguinal hernias (16 %), 15 incisional hernias (60 %) and 6 multirecurrent incisional hernias (24 %). It was performed a PRM in 92 % of cases (n = 23), a total excision of the prosthesis in 4 % of cases (n = 1) and no removal of prosthesis in 4 % of cases (n = 1). The average number of reoperations before healing was 1 (range 1-5). The mean cumulative duration of hospitalization until healing was 9.5 days (range 2-43). No visceral resection was performed.
PRM is feasible in most cases allowing first to spare the capital parietal patients and secondly to avoid major surgery. In case of failure, total removal of the mesh can be discussed.
使用假体网片进行开放式无张力疝修补术大大降低了疝或切口疝修补术后的复发率，已成为常规手术。网片感染（MI）是假体材料的主要并发症。本研究旨在评估部分切除网片（PRM）治疗 MI 的疗效。
从 2000 年 1 月至 2010 年 4 月，我们从一个前瞻性数据库中回顾性选择了接受 MI 手术的患者。我们研究了流行病学数据（性别、年龄、肥胖、糖尿病、吸烟）、首次干预的手术时间、首次干预时是否存在肠损伤、初次手术和 MI 之间的平均间隔时间、疝的位置、疝的平均大小、使用的网片类型、网片的位置、手术类型、治愈所需的干预次数、住院总时间和疝复发率。
在我们的机构中，有 25 例患者因 MI 得到支持。其中 9 例为女性（36%），16 例为男性（64%）。中位年龄为 59 岁（范围 37-78 岁）。有 4 例腹股沟疝（16%），15 例切口疝（60%）和 6 例多发性复发性切口疝（24%）。92%（n=23）的病例行 PRM，4%（n=1）的病例行假体完全切除，4%（n=1）的病例未切除假体。治愈前平均再手术次数为 1 次（范围 1-5 次）。平均住院时间直到治愈为 9.5 天（范围 2-43 天）。未进行内脏切除术。
PRM 在大多数情况下是可行的，首先可以节省患者的资本壁，其次可以避免大手术。如果失败，可以考虑完全切除网片。
