Hodgman Erica I, Watson Mark J
Department of Surgery, University of Texas - Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-8548, USA.
World J Surg. 2017 Mar;41(3):713-721. doi: 10.1007/s00268-016-3774-9.
Surgeons continue to seek an incisional hernia repair technique which minimizes cost and morbidity while maximizing durability. We present a single surgeon's experience with a technique described by N.L. Browse and J.P. Chevrel in 1979.
The Chevrel/Browse repair consists of a bilateral anterior rectus sheath release, hernia sac imbrication, bilateral rectus complex medialization, and repair reinforcement with an anterior prosthetic mesh. Data were collected on all patients who underwent herniorrhaphy between April 2003 and April 2013.
A total of 123 patients underwent repair. These had undergone an average of 2.6 prior abdominal operations and 0.7 prior hernia repairs; the average defect size was 64.77 ± 86.79 cm. Twelve patients had lateral components release in addition to release of the anterior rectus sheath to achieve midline re-approximation with minimal tension. Synthetic mesh was used in 81 % of repairs and biologic mesh in 19 %. The most common complications were seroma formation (21 %) and incisional skin breakdown (30 %); no deaths occurred. The overall recurrence rate was 5.1 %, and 7 % for the group which had follow-up greater than 36 months. Use of biologic mesh increased the rate of seroma formation compared with synthetic mesh (50 vs. 14 %, p < 0.001), but did not increase the rate of wound breakdown (36.3 vs. 29.6 %, p = 0.72).
This case series describes the utilization of anterior rectus sheath release and mesh placement which is anterior to the rectus muscle. Hernia recurrence and intra-abdominal complications are observed to be uncommon after repair using this technique. Future prospective randomized studies are warranted.
外科医生一直在寻找一种切口疝修补技术，该技术能在将成本和发病率降至最低的同时，使耐用性最大化。我们介绍一位外科医生采用1979年由N.L. 布劳斯和J.P. 谢夫雷尔描述的一种技术的经验。
谢夫雷尔/布劳斯修补术包括双侧腹直肌前鞘松解、疝囊叠瓦状缝合、双侧腹直肌复合体向内侧移位，以及用前部人工补片加强修补。收集了2003年4月至2013年4月期间所有接受疝修补术患者的数据。
共有123例患者接受了修补。这些患者平均之前接受过2.6次腹部手术和0.7次疝修补术；平均缺损大小为64.77±86.79平方厘米。12例患者除了腹直肌前鞘松解外还进行了外侧成分松解，以在最小张力下实现中线重新对合。81%的修补使用了合成补片，19%使用了生物补片。最常见的并发症是血清肿形成（21%）和切口皮肤裂开（30%）；无死亡病例。总体复发率为5.1%，随访超过36个月的组复发率为7%。与合成补片相比，使用生物补片增加了血清肿形成的发生率（50%对14%，p<0.001），但未增加伤口裂开的发生率（36.3%对29.6%，p=0.72）。
本病例系列描述了腹直肌前鞘松解和在腹直肌前方放置补片的应用。采用该技术修补后，疝复发和腹腔内并发症并不常见。未来有必要进行前瞻性随机研究。
