Stoppa R E, Warlaumont C R, Verhaeghe P J, Romero E R, M'Balla-N'Di C J
Int Surg. 1986 Jul-Sep;71(3):154-8.
Prosthetic repairs are an important development in herniology because of their excellent results. Reinforcement or replacement of the fascia transversalis is performed by interposition of a synthetic mesh between muscles and peritoneum aiming at the restoration of the tightness of the abdominal wall against the intra-abdominal pressure. All synthetic materials are not equally appropriate; Marlex mesh has been used exclusively in this report. The midline preperitoneal way allows the placement of large bilateral prostheses kept in place by intra-abdominal pressure; they need not be fixed nor associated with any suturing of the hernial hole. This is a very easy operation even in multirecurrent hernias. Because of the more disagreeable septic accidents after prosthetic repair, an important question is related to its indications, which must be selective. Randomized studies, comparing diverse techniques, are unlikely to lead to an exclusive choice because hernias are polymorphous lesions and also because of the time lag-factor and suturing must be followed up for 20 years. In socioeconomic terms, a prosthesis is the most appropriate treatment for hernias liable to recur. Nowadays it is impossible to reject the remarkable possibilities offered by prostheses in hernial surgery after the developments of the past 20 years.
由于修复效果良好，人工修复是疝科学领域的一项重要进展。通过在肌肉和腹膜之间置入合成补片来加强或替代腹横筋膜，旨在恢复腹壁抵抗腹内压的紧绷度。并非所有合成材料都同样适用；本报告仅使用了Marlex补片。中线腹膜前入路可放置大型双侧补片，利用腹内压固定补片；无需固定补片，也无需缝合疝孔。即使是多次复发的疝，这也是一项非常简单的手术。由于人工修复后感染并发症较多，一个重要问题与其适应证有关，必须进行选择。比较不同技术的随机研究不太可能得出唯一选择，这是因为疝是多形性病变，还因为存在时间滞后因素，且缝合必须随访20年。从社会经济角度来看，对于易复发的疝，补片是最合适的治疗方法。在过去20年取得进展之后，如今已不可能拒绝补片在疝手术中所提供的显著可能性。
