Hasbahceci Mustafa, Basak Fatih
Department of General Surgery, Bezmialem Vakif University Faculty of Medicine, Vatan Str., 4th Floor, Fatih, Istanbul, Turkey,
Surg Today. 2014 Feb;44(2):227-32. doi: 10.1007/s00595-013-0595-4. Epub 2013 Apr 26.
Repair of giant incisional hernia is still associated with high postoperative morbidity and recurrence rates. We evaluated the effectiveness of placing the hernia sac between the viscera and the polypropylene mesh in the repair.
The subjects of this study were patients with an incisional hernia at least 15 cm in diameter, diagnosed between June 2004 and October 2010 and treated with on-lay polypropylene mesh at least 25 cm in length. We operated using a simplified method of placing the hernia sac between the viscera and the mesh, and fixing the mesh with interrupted trans-fascial U sutures. We evaluated the patient demographics and postoperative complications retrospectively.
A total of 25 patients (mean age 57.1 ± 10 years) were included. The mean length of hospital stay was 1.8 ± 1.2 days. Seroma developed in four patients (16 %), but only two with cystic seroma required excision of the cyst wall with preservation of the mesh. Twenty-two patients (88 %) were followed up for a mean period of 42.6 ± 23 months. There was no incidence of chronic pain, hospitalization for intestinal obstruction, or enterocutaneous fistulization. There was only one recurrence (4.55 %).
The hernia sac can be interposed in all patients undergoing giant incisional hernia repair if direct contact between the polypropylene mesh and intestine is unavoidable.
巨大切口疝修补术后的发病率和复发率仍然很高。我们评估了在修补术中将疝囊置于内脏与聚丙烯补片之间的有效性。
本研究的对象为2004年6月至2010年10月期间诊断为直径至少15 cm的切口疝且接受长度至少25 cm的聚丙烯补片外置修补术的患者。我们采用一种简化方法进行手术，即将疝囊置于内脏与补片之间，并用间断经筋膜U形缝线固定补片。我们回顾性评估了患者的人口统计学资料和术后并发症。
共纳入25例患者（平均年龄57.1±10岁）。平均住院时间为1.8±1.2天。4例患者（16%）出现血清肿，但只有2例囊性血清肿患者需要切除囊壁并保留补片。22例患者（88%）接受了平均42.6±23个月的随访。无慢性疼痛、因肠梗阻住院或肠皮肤瘘形成的情况发生。仅1例复发（4.55%）。
如果聚丙烯补片与肠管之间不可避免地发生直接接触，那么在所有接受巨大切口疝修补术的患者中均可将疝囊置于两者之间。
