Kumar R, Shrestha A K, Basu S
Department of General Surgery, General Surgical Directorate, William Harvey Hospital, East Kent Hospitals University NHS Foundation Trust, Kennington Road, Willesborough, Ashford, Kent, TN24 0LZ, UK.
Hernia. 2014 Oct;18(5):631-6. doi: 10.1007/s10029-014-1239-3. Epub 2014 Mar 28.
Giant midline abdominal wall incisional herniae require repair/reconstruction to restore the structural and functional continuity of the anterior abdominal wall. We describe here our approach to these demanding cases through a combined retro-rectus mesh placement and components separation and their overall functional outcome.
A retrospective analysis of a prospectively collected data was carried out and 28 patients who underwent giant (≥15 cm) midline incisional hernia reconstruction were identified in a large district general hospital between 2007 and 2013 with a median follow-up of 34 (6-76) months.
Demographic data of our series include age of 60 (median) (30-87) years with a M:F ratio of 12:16, length of symptomatic hernia 18 (median) (12-36) months, more than two previous laparotomies (15), bowel obstructive symptoms (7) and recurrent herniation (7). BMI recorded was 32 (median) (24-46) and ASA of II (median) (I-III). Co-morbidities included cardiac disease (6), diabetes (6), respiratory disease (4) and systemic immunocompromise (2). Operative and technical details showed operative duration to be 180 (median) min, cranio-caudal rectus sheath defect 21 (median) cm, transverse rectus sheath defect 15 (median) cm, cross-sectional area of fascial defect 300 (median) cm(2) and size of mesh 690 (median) cm(2). Seven (25 %) developed short-term post operative complications: grade I seromata all resolving spontaneously (5); grade II superficial wound infections (2). Twenty-five (89 %) were completely asymptomatic at 34 (median) months' follow-up; 2 (7 %) reported mild pain, but not limiting any activity; 1 (4 %) described pain occasionally limiting activity. There was no clinical recurrence with one patient developing global bulging.
Our series is comparable to the literature in patient cohort demographics, co-morbidity and risk factor profile; however, we demonstrate an excellent intermediate term outcome with no clinical recurrence and an improvement in quality of life, through their ability to perform normal day to day activities.
巨大的腹壁中线切口疝需要进行修复/重建，以恢复前腹壁的结构和功能连续性。在此，我们描述了通过联合腹直肌后补片置入和组织分离术来处理这些复杂病例的方法及其整体功能结果。
对前瞻性收集的数据进行回顾性分析，在一家大型地区综合医院中确定了28例接受巨大（≥15 cm）中线切口疝重建术的患者，这些患者于2007年至2013年接受手术，中位随访时间为34（6 - 76）个月。
我们这组患者的人口统计学数据包括年龄中位数为60（30 - 87）岁，男女比例为12:16，有症状疝的时长中位数为18（12 - 36）个月。既往有超过两次剖腹手术史的患者有15例，有肠梗阻症状的患者有7例，复发性疝患者有7例。记录的体重指数（BMI）中位数为32（24 - 46），美国麻醉医师协会（ASA）分级中位数为II（I - III）。合并症包括心脏病（6例）、糖尿病（6例）、呼吸系统疾病（4例）和全身免疫功能低下（2例）。手术及技术细节显示手术时长中位数为180分钟，腹直肌鞘头尾方向缺损中位数为21 cm，腹直肌鞘横向缺损中位数为15 cm，筋膜缺损横截面积中位数为300 cm²，补片大小中位数为690 cm²。7例（25%）患者出现短期术后并发症：I级血清肿均自行消退（5例）；II级浅表伤口感染（2例）。在34个月（中位数）的随访中，25例（89%）患者完全无症状；2例（7%）报告有轻度疼痛，但不影响任何活动；1例（4%）称疼痛偶尔会限制活动。无临床复发情况，1例患者出现整体膨隆。
我们这组患者在患者队列人口统计学、合并症和风险因素方面与文献报道相当；然而，我们通过患者能够进行正常日常活动，展示了良好的中期结果，无临床复发且生活质量有所改善。
