Kohoutek L, Plecháčová P, Roxer R, Musil J, Karkošková B
Rozhl Chir. 2018 Summer;97(10):459-463.
Incisional hernias represent one of the most complex and widely discussed issues of abdominal wall surgery. 10-20% of the cases occur following abdominal surgery. The aim of this study is to describe our surgical experience and determine whether the intraperitoneal onlay mesh (IPOM) procedure is suitable for hernia surgery with minimal postoperative complications.
The paper focuses on patients operated on by the IPOM technique between 2015 and 2016. The group involved 53 patients with median or paramedian defects after acute or elective abdominal surgery. In patients with comorbidities, thorough preoperative examination was completed including abdominal ultrasound, colonoscopy and spirometry. In the postoperative period, we evaluated pain using the visual analogue scale, wound healing, relapses and patient´s satisfaction with functional as well as aesthetic outcomes of the surgery.
Our group comprised 53 patients operated on using the IPOM technique. They were 4879 years old with a body mass index exceeding 30 kg/m2. 18 patients had a paramedian hernia and 35 patients median hernia. 4 patients suffered a perioperative iatrogenic injury of the intestine, 8 cases developed postoperative paralytic ileus. Wound infection or infection of the mesh was not recorded. 2 patients with hernia recurrence were followed up for one year.
Incisional hernias represent an important surgical issue. Management is often complex. IPOM as the treatment of choice for patients with incisional hernias appears to be beneficial. However, it requires careful patient selection, patient preparation for surgery and their compliance, the surgeons extensive experience as well as excellent postoperative care with limited postoperative pain. The success rate of this method is high in carefully selected patients. Key words: IPOM - incisional hernia - patient compliance.
切口疝是腹壁外科最复杂且讨论最广泛的问题之一。10% - 20%的病例发生于腹部手术后。本研究的目的是描述我们的手术经验，并确定腹膜内补片植入修补术（IPOM）是否适用于疝修补手术，同时使术后并发症最少。
本文重点关注2015年至2016年期间采用IPOM技术进行手术的患者。该组包括53例在急性或择期腹部手术后出现正中或旁正中缺损的患者。对于合并其他疾病的患者，完成了全面的术前检查，包括腹部超声、结肠镜检查和肺活量测定。在术后期间，我们使用视觉模拟量表评估疼痛情况、伤口愈合情况、复发情况以及患者对手术功能和美学效果的满意度。
我们的研究组包括53例采用IPOM技术进行手术的患者。他们的年龄在48 - 79岁之间，体重指数超过30kg/m²。18例患者患有旁正中疝，35例患者患有正中疝。4例患者在围手术期发生了医源性肠损伤，8例患者出现了术后麻痹性肠梗阻。未记录到伤口感染或补片感染情况。对2例疝复发患者进行了为期一年的随访。
切口疝是一个重要的外科问题。其治疗通常较为复杂。IPOM作为切口疝患者的首选治疗方法似乎是有益的。然而，这需要仔细选择患者、让患者做好手术准备并确保其依从性，需要外科医生有丰富的经验以及提供出色的术后护理，同时使术后疼痛有限。在精心挑选的患者中，这种方法的成功率较高。关键词：IPOM - 切口疝 - 患者依从性
