Munegato Gabriele, Fei Landino, Schiano di Visconte Michele, Da Ros Danilo, Moras Luana, Bellio Gabriele
Unit of General Surgery, Conegliano Hospital, Treviso, Italy.
Unit of Gastrointestinal Surgery, School of Medicine, Second University of Naples, Naples, Italy.
Updates Surg. 2017 Dec;69(4):485-491. doi: 10.1007/s13304-017-0493-1. Epub 2017 Oct 13.
In the surgical management of large incisional hernias, the main target is the closure of the abdominal wall defect on the midline without a dangerous increase in the intraabdominal pressure. In this setting, new intraperitoneal prosthesis and components separation techniques were proposed to solve this problem. Both solutions present some critical issues. A new surgical approach with a free lateral double layer prosthesis totally in polypropylene both sides (FLaPp) is proposed to overcome this problem. This is a retrospective cohort analysis study with a prospectively collected database from two different Italian hospitals. Twenty-nine patients operated from April 2010 to December 2015 were treated using the new prosthesis. Four patients developed postoperative complications: one (3.4%) presented wound infection, two (6.9%) experienced seroma, and one had a hematoma (3.4%). No deaths were recorded. At a median follow-up of 28.5 months (IQR 22-36), no hernia relapse occurred. The application of FLaPp mesh is a safe and feasible option that can be employed to manage Rives repair in cases of abdominal wall defects with difficult closure of the posterior plan when the conventional prosthetic meshes could be unsuitable.
在大型切口疝的外科治疗中，主要目标是关闭中线处的腹壁缺损，同时避免腹内压危险地升高。在这种情况下，人们提出了新的腹膜内假体和组织分离技术来解决这一问题。这两种解决方案都存在一些关键问题。为此，我们提出了一种新的手术方法，即使用完全由聚丙烯制成的双侧游离外侧双层假体（FLaPp）来克服这一问题。这是一项回顾性队列分析研究，其数据库前瞻性地收集自两家不同的意大利医院。2010年4月至2015年12月期间接受手术的29例患者使用了这种新型假体。4例患者出现术后并发症：1例（3.4%）发生伤口感染，2例（6.9%）出现血清肿，1例出现血肿（3.4%）。无死亡病例记录。中位随访28.5个月（四分位间距22 - 36）时，无疝复发。当传统的假体网片可能不合适时，FLaPp网片的应用是一种安全可行的选择，可用于处理后壁难以闭合的腹壁缺损病例中的里夫斯修补术。
