Khansa Ibrahim, Janis Jeffrey E
Department of Plastic Surgery, the Ohio State University Wexner Medical Center, Columbus, Ohio.
Plast Reconstr Surg Glob Open. 2016 Nov 23;4(11):e1145. doi: 10.1097/GOX.0000000000001145. eCollection 2016 Nov.
In abdominal wall reconstruction, the retrorectus plane offers an ideal location for mesh placement. Mesh fixation in this plane is often achieved using transfascial sutures, which risks entrapping intercostal nerves and causing significant pain, and takes time to place. A novel alternative is the use of sutureless self-adhering mesh. Although the use of this mesh in inguinal hernias has been well described, studies on its use in abdominal wall reconstruction are lacking.
Consecutive patients who underwent ventral hernia repair with retrorectus mesh were reviewed. This included patients who received transfascially sutured mesh and those who received sutureless self-adhering mesh. All patients were followed up for at least 12 months. The amount of narcotics required by each patient postoperatively was calculated. Surgical-site occurrences (SSOs) and hernia recurrence and bulge were measured.
Twenty-six patients underwent abdominal wall reconstruction with retrorectus mesh. This included 12 patients with transfascially sutured mesh and 14 patients with self-adhering mesh. Mean follow-up was 600 days. Baseline characteristics were similar between the 2 groups. Patients receiving self-adhering mesh required significantly less narcotics than patients with transfascially sutured mesh. There were no significant differences in the rate of SSOs between the 2 groups. No hernia recurrences, bulges, or chronic pain occurred in either group.
This is the first study to compare the outcomes of retrorectus self-adhering mesh and transfascially sutured mesh in abdominal wall reconstruction. Our results show low rates of SSO, recurrence, and bulge with both options, with significantly less acute pain with self-adhering mesh.
在腹壁重建中，腹直肌后平面为补片放置提供了理想位置。在此平面进行补片固定通常采用经筋膜缝合，这有压迫肋间神经并导致严重疼痛的风险，且放置补片耗时。一种新的替代方法是使用无缝合自粘补片。虽然这种补片在腹股沟疝中的应用已有详细描述，但在腹壁重建中的应用研究尚缺。
回顾性分析连续接受腹直肌后补片修补腹疝的患者。这包括接受经筋膜缝合补片的患者和接受无缝合自粘补片的患者。所有患者均随访至少12个月。计算每位患者术后所需麻醉药量。测量手术部位事件（SSO）、疝复发和膨出情况。
26例患者接受了腹直肌后补片腹壁重建。其中12例采用经筋膜缝合补片，14例采用自粘补片。平均随访600天。两组基线特征相似。接受自粘补片的患者所需麻醉药明显少于经筋膜缝合补片的患者。两组SSO发生率无显著差异。两组均未发生疝复发、膨出或慢性疼痛。
这是第一项比较腹直肌后自粘补片和经筋膜缝合补片在腹壁重建中疗效的研究。我们的结果显示，两种方法的SSO、复发和膨出发生率均较低，自粘补片引起的急性疼痛明显减轻。
