Punjani Ramesh, Shaikh Imran, Soni Vinne
Fortis Hospital, Mulund Goregaon Link Road, Mumbai, 400080 India.
Indian J Surg. 2015 Dec;77(Suppl 3):1476-9. doi: 10.1007/s12262-015-1265-0. Epub 2015 Apr 10.
Repair of large ventral hernia is a challenge for even experienced surgeons, as there are large defects with large contents, often with loss of domain. The large defects were bridged by various plastic surgical procedures like myofascial flaps or free flaps with high recurrences and complications. More often, the bridging was done with artificial prosthesis, leaving the defects open. This was accomplished by either open surgery (onlay, inlay, sublay or underlay) or laparoscopic intraperitoneal onlay meshes (IPOMs). However, non-closure of the midline had adverse effects on postural maintenance, respiration, micturition, defecation and biomechanical properties, which have a profound impact on the patients' overall physical capacity and quality of life. Component separation technique (CST) is a novel answer to the closure of midline with live, active tissues with or without the use of additional prosthesis. Though this technique was originally described in 1990, it has undergone lots of modifications like perforator preserving CST, endoscopic technique and posterior component separation. So, we present a series of 22 patients with large ventral hernia repaired using various options of component separation technique in the last 3 years.
即使对于经验丰富的外科医生来说,修复大型腹侧疝也是一项挑战,因为存在大的缺损且内容物较多,通常还伴有组织缺失。大的缺损通过各种整形手术方法来填补,如肌筋膜瓣或游离皮瓣,但复发率和并发症较高。更多时候,是用人造假体来填补缺损,使缺损敞开。这可通过开放手术(覆盖法、嵌入法、衬里法或底层法)或腹腔镜腹膜内覆盖补片(IPOM)来完成。然而,中线不闭合对姿势维持、呼吸、排尿、排便及生物力学特性都有不利影响,这对患者的整体身体能力和生活质量有深远影响。组织分离技术(CST)是一种用有活力的活性组织闭合中线的新方法,可使用或不使用额外的假体。尽管该技术最初于1990年被描述,但它经历了许多改进,如保留穿支的CST、内镜技术和后入路组织分离。因此,我们展示了过去3年中使用各种组织分离技术修复22例大型腹侧疝患者的系列病例。