Posielski N M, Yee S T, Majumder A, Orenstein S B, Prabhu A S, Novitsky Y W
Department of Surgery, Case Comprehensive Hernia Center, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
Hernia. 2015 Jun;19(3):465-72. doi: 10.1007/s10029-015-1375-4. Epub 2015 Apr 9.
Prosthetic reinforcement is a critical component of hernia repair. For massive defects, mesh overlap is often limited by the dimensions of commercially available implants. In scenarios where larger mesh prosthetics are required for adequate reinforcement, it may be necessary to join several pieces of mesh together using non-absorbable suture. Here, we report our outcomes for abdominal wall reconstructions in which "quilted" mesh was utilized for fascial reinforcement.
Patients undergoing open incisional hernia repair utilizing posterior component separation and transversus abdominis muscle release, with use of quilted synthetic mesh placed in the retromuscular position, were reviewed. Main outcome measures included patient, hernia, and operative characteristics and post-operative outcomes, including surgical site occurrence (SSO), surgical site infection (SSI), and recurrence.
Thirty-two patients (mean age 55.7 ± 9.3, BMI 38.3 ± 5.8 kg/m(2)) underwent open ventral hernia repair with "quilted" mesh placed in the retromuscular position. The mean defect area was 760.1 ± 311.0 cm(2) with a mean width of 24.7 ± 6.4 cm. Quilted meshes consisted of two-piece (69 %), three-piece (19 %) and four-piece (12 %) configurations. Wound morbidity consisted of eight (25 %) SSOs, including four (13 %) SSIs, all of which resolved without mesh excision. With mean follow-up of 9.0 ± 13.6 months, there were two (6.3 %) lateral recurrences, both unassociated with mesh-to-mesh suture line failure.
Massive ventral hernias that require giant mesh prosthetics, currently not commercially available, may be successfully repaired using multiple mesh pieces sewn together in a quilt-like fashion. Such retromuscular repairs are durable, without added morbidity due to the mesh-to-mesh suture line. However, additional operative time is required for quilting the mesh together, prompting strong calls for manufacturing of larger mesh prosthetics.
假体加固是疝修补术的关键组成部分。对于巨大缺损，网片重叠通常受市售植入物尺寸的限制。在需要更大尺寸网片假体进行充分加固的情况下，可能有必要使用不可吸收缝线将几片网片连接在一起。在此，我们报告使用“缝褶”网片进行筋膜加固的腹壁重建结果。
回顾性分析采用后入路成分分离和腹横肌松解进行开放切口疝修补，并在肌后间隙放置缝褶合成网片的患者。主要观察指标包括患者、疝和手术特征以及术后结果，包括手术部位事件（SSO）、手术部位感染（SSI）和复发情况。
32例患者（平均年龄55.7±9.3岁，体重指数38.3±5.8kg/m²）接受了在肌后间隙放置“缝褶”网片的开放腹侧疝修补术。平均缺损面积为760.1±311.0cm²，平均宽度为24.7±6.4cm。缝褶网片由两片（69%）、三片（19%）和四片（12%）配置组成。伤口并发症包括8例（25%）手术部位事件，其中4例（13%）为手术部位感染，所有这些均未切除网片而痊愈。平均随访9.0±13.6个月，有2例（6.3%）外侧复发，均与网片间缝线失败无关。
对于需要巨大网片假体（目前尚无市售产品）的巨大腹侧疝，可通过将多个网片以缝褶样方式缝合在一起成功修复。这种肌后间隙修补术是持久的，不会因网片间缝线导致额外的并发症。然而，将网片缝褶在一起需要额外的手术时间，这强烈呼吁生产更大尺寸的网片假体。
