Köckerling Ferdinand
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany.
Front Surg. 2019 Apr 17;6:15. doi: 10.3389/fsurg.2019.00015. eCollection 2019.
In publications on ventral incisional hernia repair, the Chevrel technique and the onlay operation are often equated. This present review now aims to present the difference between these surgical techniques and analyze the findings available on the Chevrel technique. A systematic search of the available literature was performed in January 2019 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library, as well as a search of relevant journals, books, and reference lists. Thirty-four publications were identified as relevant for this review. For assessment of the Chevrel-technique with other surgical procedures there are no randomized controlled trials, prospective or retrospective comparative studies available but only case series. In the majority of case series the follow-up procedure is not reported. In the onlay technique the defect is closed with direct suture or it is omitted altogether. Whereas, in the Chevrel technique this is done with sliding myofascial flaps harvested from the rectus sheaths. In the few case series available this appears to result in a lower recurrence rate for the Chevrel technique compared with the onlay technique. However, the rates of postoperative complications, surgical site occurrences (SSOs), surgical site infections (SSIs), seroma, and skin necrosis are as high as in the onlay technique. The reason for this is that both techniques require subcutaneous undermining with severance of perforator vessels. If mesh placement in onlay position has been chosen for specific reasons, preference can be given to the Chevrel technique over the standard onlay technique, although the study quality is limited.
在关于腹直肌切口疝修补的出版物中，谢弗雷尔技术和补片修补术常常被等同看待。本综述旨在阐述这些手术技术之间的差异，并分析有关谢弗雷尔技术的现有研究结果。2019年1月，我们使用Medline、PubMed、Scopus、Embase、Springer Link和Cochrane图书馆对现有文献进行了系统检索，同时检索了相关期刊、书籍和参考文献列表。共确定了34篇与本综述相关的出版物。对于评估谢弗雷尔技术与其他手术方法，目前尚无随机对照试验、前瞻性或回顾性比较研究，仅有病例系列报道。在大多数病例系列中，未报告随访程序。在补片修补术中，缺损用直接缝合关闭或完全不缝合。而在谢弗雷尔技术中，缺损是通过从腹直肌鞘获取的滑动肌筋膜瓣来关闭的。在现有的少数病例系列中，与补片修补术相比，谢弗雷尔技术的复发率似乎较低。然而，其术后并发症、手术部位事件（SSO）、手术部位感染（SSI）、血清肿和皮肤坏死的发生率与补片修补术一样高。原因在于这两种技术都需要进行皮下潜行分离并切断穿支血管。如果出于特定原因选择在补片修补位置放置补片，尽管研究质量有限，但与标准补片修补术相比，谢弗雷尔技术可能更受青睐。
