Rea Roberto, Falco Paolo, Izzo Domenico, Leongito Maddalena, Amato Bruno
Department of General Surgery, Clinica Mediterranea, Via Orazio 2, 80122 Napoli, Italy.
BMC Surg. 2012;12 Suppl 1(Suppl 1):S33. doi: 10.1186/1471-2482-12-S1-S33. Epub 2012 Nov 15.
The treatment of ventral hernias is still a subject of debate. The affixing of a prosthesis and the subsequent introduction of laparoscopic treatment have reduced complications and recurrences. The high incidence of seromas and high costs remain open problems.
At our Department between January 2008 and December 2011, 87 patients (43 over 65 years), out of a total of 132, with defects of wall whose major axis was less than 10 cm, or minor and multiple defects (Swiss-cheese defect) on an axis not exceeding 12 cm underwent laparoscopic ventral hernia repair (LVHR) with primary and transparietal closure of the hernial defect. Through small incisions in the skin we proceeded to close the parietal defect with sutures tied outside. Then the mesh was fixed as usual with double row of stitches and an overlap of 3-5 cm.
In all patients, 43 of them elderly, surgery was successfully conducted. The juxtaposition of the edges of the hernial defect has not been time consuming and has not developed new complications. The postoperative course was uneventful, with discharge on the third day, except in 5 patients. Were observed only small gaps and not the formation of large seromas. There were no infections wall. We do not have relapses, but some small and asymptomatic solutions continuously up to 2 cm at the sonographic study. In elderly patients the absence of dead space and the feeling of greater stability of the wall, early mobilization and pain control have facilitated the post-operative course.
The positioning of sutures transcutaneous is simple and effective, the reduced incidence of seromas and the greater stability of the wall suggest to adopt this procedure fully.The possibility to close the margins of the defect may allow to change the size and setting of the mesh, since the absence of dead space allows to download physiologically tensions of the wall.
腹疝的治疗仍是一个有争议的话题。假体的固定以及随后腹腔镜治疗方法的引入减少了并发症和复发率。血清肿的高发生率和高成本仍然是有待解决的问题。
2008年1月至2011年12月期间，在我们科室，132例患者中有87例（43例年龄超过65岁）接受了腹腔镜腹疝修补术（LVHR），这些患者的腹壁缺损长轴小于10 cm，或短轴及多个缺损（瑞士奶酪样缺损），轴长不超过12 cm，同时对疝缺损进行了一期经壁闭合。通过皮肤上的小切口，我们用在体外打结的缝线来闭合腹壁缺损。然后像往常一样用双排缝线固定补片，重叠3 - 5 cm。
所有患者，其中43例为老年患者，手术均成功进行。疝缺损边缘的对合并不耗时，也未出现新的并发症。术后过程顺利，除5例患者外，其余患者均在第三天出院。仅观察到小的间隙，未形成大的血清肿。没有发生腹壁感染。我们没有复发情况，但在超声检查中发现有一些直径持续达2 cm的小的无症状疝修补处。在老年患者中，没有死腔以及腹壁稳定性增强的感觉、早期活动和疼痛控制都有利于术后恢复过程。
经皮缝合定位简单有效，血清肿发生率降低以及腹壁稳定性增强表明应充分采用该手术方法。闭合缺损边缘的可能性可能允许改变补片的尺寸和放置方式，因为没有死腔可以生理性地减轻腹壁的张力。
