Tenzel Paul L, Johnson Robert G, Bilezikian Jordan A, Powers William F, Hope William W
Department of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina.
epartment of Surgery, New Hanover Regional Medical Center, Wilmington, North Carolina.
Surg Technol Int. 2019 May 15;34:251-254.
A common technique for ventral and incisional hernia repair is the retrorectus repair (Rives-Stoppa). The posterior rectus sheath is incised bilaterally, and mesh is placed retromuscularly. There is little information on how this component separation technique affects abdominal wall tension. We evaluated abdominal wall tension in patients undergoing retrorectus repair of abdominal wall hernias. Patients undergoing retrorectus repair of their ventral hernias were enrolled in a prospective, Institutional Review Board-approved protocol to measure abdominal wall tension from 8/1/2013 to 8/2/2017. Demographic information and operative details were documented. Abdominal wall tensions were measured using scales attached to Kocher clamps that were clamped to the fascia and brought together in the midline. Measurements were made before and after incising the posterior rectus sheaths. Data were analyzed with a repeated measures analysis of variance (ANOVA), and differences between individual groups were analyzed by least square differences. Forty-five patients had tension measurements. Average age was 58 years (range 29-81)-78% Caucasian, 51% female, an average body mass index (BMI) of 35 kg/m2 (range 20-62), and 38% recurrent hernias. The average hernia defect was 121.9 cm2, and the average mesh size was 607.8 cm2. There was a significant reduction in tension after bilateral posterior rectus sheath incision (3.1 lbs vs. 5.6 lbs, p<0.0001). In this evaluation, abdominal wall tension measurements are shown to be a feasible adjunct during open hernia repair with retrorectus repair. Transection of the posterior rectus sheath decreases tension during hernia repair and may help guide surgeons regarding when to use this procedure.
腹直肌后鞘修补术（里夫斯 - 斯托帕手术）是腹侧疝和切口疝修补的常用技术。双侧切开腹直肌后鞘，将补片置于肌肉后方。关于这种组织分离技术如何影响腹壁张力的信息很少。我们评估了接受腹壁疝腹直肌后鞘修补术患者的腹壁张力。接受腹侧疝腹直肌后鞘修补术的患者被纳入一项前瞻性、经机构审查委员会批准的方案，以测量2013年8月1日至2017年8月2日期间的腹壁张力。记录人口统计学信息和手术细节。使用连接到 Kocher 钳的秤测量腹壁张力，Kocher 钳夹在筋膜上并在中线处并拢。在切开腹直肌后鞘之前和之后进行测量。数据采用重复测量方差分析（ANOVA）进行分析，各单独组之间的差异通过最小二乘差异分析。45例患者进行了张力测量。平均年龄为58岁（范围29 - 81岁），78%为白种人，51%为女性，平均体重指数（BMI）为35 kg/m²（范围20 - 62），38%为复发性疝。平均疝缺损为121.9 cm²，平均补片大小为607.8 cm²。双侧腹直肌后鞘切开后张力显著降低（3.1磅对5.6磅，p<0.0001）。在本评估中，腹壁张力测量显示在腹直肌后鞘修补的开放性疝修补术中是一种可行的辅助手段。腹直肌后鞘横断术可降低疝修补术中的张力，并可能有助于指导外科医生何时使用该手术。
