Nguyen David, Szomstein Samuel, Ordonez Alex, Dip Fernando, Rajan Meenakshi, Menzo Emanuele Lo, Rosenthal Raul J
Department of General Surgery, Section of Minimally Invasive Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic Florida, 2950 Cleveland Clinic Boulevard, Weston, FL, 33331, USA.
Surg Endosc. 2016 Feb;30(2):764-769. doi: 10.1007/s00464-015-4275-x. Epub 2015 Jun 24.
Incisional hernias remain a significant complication of abdominal surgeries. Primary closure of the hernia defect has been suggested to improve long-term abdominal wall function. However, this can be technically challenging and time consuming. This study describes laparoscopic use of non-absorbable barbed sutures in primary closure of hernia defects in addition to intraperitoneal mesh.
Patients who underwent laparoscopic primary ventral hernia repair with mesh were prospectively reviewed. Two groups were defined: Operations performed with barbed sutures for primary closure in addition to mesh and operations with only mesh without defect repair. The surgical technique involved running the hernia defect with a 2-polypropylene non-absorbable unidirectional barbed suture and subsequently fixing the mesh intraperitoneally with tacks. In both groups, a single transfascial centering suture was also utilized.
Twenty-eight cases with barbed suture and mesh reinforcement and 29 cases with mesh-only were identified. The average dimensions of the ventral hernia defects were 57.8 (6-187) and 44.6 cm(2) (9-156) in the barbed suture with mesh and mesh-only group, respectively, p = 0.23. Median operating time was 78 min (range 35-187 min) in the barbed suture with mesh group versus 62 min (34-155 min) in the mesh-only group, p = 0.44. The median suturing time of closing the ventral hernia defect was 16 min (11-24 min). There were no differences in the pain scores. Mean follow-up for both groups was 8.2 ± 3.6 months (1-17 months) with one hernia recurrence in the mesh-only group, p = 0.41.
The barbed suture closure system could be used for rapid and effective primary defect closure in laparoscopic ventral hernia repair in addition to intraperitoneal mesh placement. No significant difference in operating time was detected when compared to the mesh-only approach. Further evidence to support these findings and longer follow-up periods is warranted to evaluate short- and long-term complications.
切口疝仍是腹部手术的一个重要并发症。有人提出对疝缺损进行一期缝合可改善腹壁的长期功能。然而，这在技术上可能具有挑战性且耗时。本研究描述了在使用腹腔内补片的同时，腹腔镜下使用不可吸收倒刺缝线对疝缺损进行一期缝合。
对接受腹腔镜下补片修补原发性腹疝的患者进行前瞻性评估。定义了两组：除补片外使用倒刺缝线进行一期缝合的手术，以及仅使用补片而不进行缺损修复的手术。手术技术包括用一根2-聚丙烯不可吸收单向倒刺缝线连续缝合疝缺损，随后用钉将补片固定于腹腔内。两组均使用一根经筋膜的对中缝线。
确定了28例使用倒刺缝线和补片加强的病例以及29例仅使用补片的病例。使用倒刺缝线加补片组和仅使用补片组腹疝缺损的平均尺寸分别为57.8（6 - 187）和44.6 cm²（9 - 156），p = 0.23。使用倒刺缝线加补片组的中位手术时间为78分钟（范围35 - 187分钟），而仅使用补片组为62分钟（34 - 155分钟），p = 0.44。关闭腹疝缺损的中位缝合时间为16分钟（11 - 24分钟）。疼痛评分无差异。两组的平均随访时间为8.2 ± 3.6个月（1 - 17个月），仅使用补片组有1例疝复发，p = 0.41。
除腹腔内放置补片外，倒刺缝线闭合系统可用于腹腔镜下腹疝修补术中快速有效地闭合原发性缺损。与仅使用补片的方法相比，未检测到手术时间有显著差异。需要进一步的证据来支持这些发现，并进行更长时间的随访以评估短期和长期并发症。
