Sasse Kent C, Lim Dionne C L, Brandt Jared
Western Bariatric Institute, Reno, NV, USA.
JSLS. 2012 Jul-Sep;16(3):380-6.
Repair of ventral hernias, including primary ventral hernias and incisional ventral hernias, is performed in the United States 90,000 times per year. Open or traditional ventral hernia repairs involve the significant morbidity and expense of a laparotomy and a significant risk of recurrent herniation. Laparoscopic ventral hernia repair (LVHR) may offer a less-invasive alternative with shorter length of hospital stay, fewer cardiopulmonary complications, and low recurrence rates.
225 patients underwent laparoscopic ventral hernia repairs in which carboxymethylcellulose-sodium hyaluronate coating (Sepramesh, Davol, Providence, RI) was used primarily. All cases were included prospectively from the study period of 2002 through 2009. Patient characteristics were recorded, and follow-up analysis was performed over a period of 42 mo following surgery. Recurrence, reoperations, and all complications were recorded. Mesh awareness and mesh-related pain were assessed using the hernia-specific Carolinas Comfort Scale (CCS) instrument, completed by 72 patients.
Over 42 mo of follow-up, 2 ventral hernias have recurred, and no long-term bowel erosion or fistulization has occurred. Little or no mesh-related symptoms were reported, and mean scores for mesh awareness and mesh pain were 3.6 and 3.2, respectively, on a scale from 0 - 40 (lower scores signify less pain or awareness). Two serious early complications occurred related to intestinal ileus and metal tacks producing intestinal perforation, and this led to a change in the tacking devices used.
LVHR with carboxymethylcellulose-sodium hyaluronate coating (Sepramesh) is safe and effective. Complications are rare, the repair is durable, and long-term results are good with rare recurrences, low awareness of mesh, and little pain. Technical lessons include use of at least one transfascial suture and the avoidance of metal tacks for fixation.
在美国，每年进行90000例腹疝修补手术，包括原发性腹疝和切口疝修补术。开放或传统的腹疝修补术会带来开腹手术的高发病率和高费用，且复发风险较高。腹腔镜腹疝修补术（LVHR）可能是一种侵入性较小的替代方法，具有住院时间短、心肺并发症少和复发率低的优点。
225例患者接受了主要使用羧甲基纤维素-透明质酸钠涂层（Sepramesh，Davol，普罗维登斯，罗德岛）的腹腔镜腹疝修补术。所有病例均前瞻性纳入2002年至2009年的研究期。记录患者特征，并在术后42个月进行随访分析。记录复发、再次手术和所有并发症情况。使用疝气专用的卡罗莱纳舒适度量表（CCS）工具对72例患者进行网片感知和网片相关疼痛评估。
在42个月的随访中，有2例腹疝复发，未发生长期肠侵蚀或肠瘘。报告的网片相关症状很少或没有，网片感知和网片疼痛的平均评分分别为3.6和3.2（0 - 40分制，分数越低表示疼痛或感知越少）。发生了2例严重的早期并发症，分别与肠梗阻和金属钉导致肠穿孔有关，这导致了所用固定装置的改变。
使用羧甲基纤维素-透明质酸钠涂层（Sepramesh）的LVHR安全有效。并发症罕见，修补持久，长期效果良好，复发率低，网片感知少，疼痛轻。技术经验包括使用至少一根经筋膜缝线并避免使用金属钉进行固定。
