Ramshaw Bruce, Forman Brandie Remi, Heidel Eric, Barker Elizabeth
University Surgeons Associates, Knoxville, Tennessee.
Division of Biostatistics, Department of Surgery, University of Tennessee Graduate, School of Medicine, Knoxville, Tennessee.
Surg Technol Int. 2019 May 15;34:227-234.
Laparoscopic ventral hernia repair is a commonly performed procedure with a variety of mesh options. A relatively new mesh option is a non-woven polypropylene mesh with a silicone barrier designed for intraabdominal placement. This non-woven randomly oriented polypropylene microfiber hernia mesh may have benefits with potentially better biocompatibility compared with other ventral hernia repair mesh options.
A clinical quality improvement (CQI) program was initiated for ventral hernia patients to better measure and improve outcomes. From March 2013 to September 2015, 62 laparoscopic ventral hernia repairs were performed with this non-woven polypropylene mesh on 61 patients (one patient had two separate hernia repairs). Attempts were made to obtain long-term (> 2 years) follow up.
There were 36 females and 25 males. The average age was 58.7 years (range 21-85). The average body mass index (BMI) was 36.2 (range 21.4-62.4). There were 51 (82%) incisional hernias and 11 (18%) primary hernias. There were 29 (47%) recurrent hernias. Mean hernia size was 83.4cm2 (range 1-400) and mean mesh size was 508.5cm2 (range 144-936). The mean operating room (OR) time was 108.2 minutes (range 38-418). The mean length of hospital stay was 2.7 days (range 0-13). There was one intraoperative complication-an injury to an inferior epigastric vessel that had a minor postoperative bleed that was self-limiting and required no treatment. There was one postoperative death due to aspiration on postoperative day #4. There has been one recurrence (1.6%) with long-term follow up. There were two patients (3.2%) with suture site pain postoperatively that resolved with suture site injections of local anesthetic in the clinic. There were no patients that required rehospitalization within 30 days after surgery. There were no mesh-related complications and no incidence of mesh removal was required.
The results for laparoscopic ventral hernia repair, using a relatively new non-woven randomly oriented polypropylene microfiber mesh, are good with long-term follow up completed in the majority of patients. More experience with this type of mesh could generate evidence for the benefits of this mesh material in laparoscopic ventral hernia repair.
腹腔镜腹疝修补术是一种常用手术，有多种补片可供选择。一种相对较新的补片选择是带有硅酮屏障、专为腹腔内放置设计的非编织聚丙烯补片。这种非编织、随机取向的聚丙烯微纤维疝补片可能具有一些优势，与其他腹疝修补补片相比，其生物相容性可能更好。
针对腹疝患者启动了一项临床质量改进（CQI）项目，以更好地衡量和改善治疗效果。2013年3月至2015年9月，对61例患者（1例患者接受了两次单独的疝修补术）进行了62例使用这种非编织聚丙烯补片的腹腔镜腹疝修补术。尝试进行长期（>2年）随访。
女性36例，男性25例。平均年龄58.7岁（范围21 - 85岁）。平均体重指数（BMI）为36.2（范围21.4 - 62.4）。有51例（82%）切口疝和11例（18%）原发性疝。有29例（47%）复发性疝。平均疝面积为83.4cm²（范围1 - 400），平均补片面积为508.5cm²（范围144 - 936）。平均手术室（OR）时间为108.2分钟（范围38 - 418）。平均住院时间为2.7天（范围0 - 13）。有1例术中并发症——腹壁下血管损伤，术后有少量出血，可自行限制，无需治疗。术后第4天有1例因误吸死亡。长期随访中有1例复发（1.6%）。有2例患者（3.2%）术后出现缝线部位疼痛，在门诊通过缝线部位注射局部麻醉剂后缓解。术后30天内无患者需要再次住院。无补片相关并发症，无需取出补片。
使用相对较新的非编织、随机取向的聚丙烯微纤维补片进行腹腔镜腹疝修补术的效果良好，大多数患者完成了长期随访。对这种补片的更多经验可能会为这种补片材料在腹腔镜腹疝修补术中的益处提供证据。
