Department of Upper GI Surgery, Royal Infirmary of Edinburgh, 51 Little France Cres, Edinburgh, EH16 4SA, Scotland, UK.
World J Surg. 2019 Sep;43(9):2157-2163. doi: 10.1007/s00268-019-05011-0.
Repair of large ventral hernias is challenging when primary fascial closure cannot be achieved. The peritoneal flap hernioplasty, a modification of the Rives-Stoppa retromuscular mesh repair, addresses this problem by using the hernial sac to bridge the fascial gap and isolate the mesh from both the intraperitoneal contents and the subcutaneous space. It is applicable to both midline and transverse hernias. We report the results from our institution using this repair based on a retrospective review of 251 cases.
Patients undergoing peritoneal flap hernioplasty repair from January 1, 2010-December 31, 2014 were identified from the Lothian Surgical Audit system, a prospectively maintained computer database of all surgical procedures in the Edinburgh region of southeast Scotland. Patient demographics, clinical presentation, location of the hernia and surgical treatment were obtained from the hospital case-notes. Follow-up consisted of a clinical consultation 3 months postoperatively and a retrospective review of patient files completed December 2018. Patients presenting signs of complications were assessed during a clinical review.
Two hundred and fifty-one patients underwent incisional hernia repair, 68.1% in the midline and 31.9% arising through transverse incisions. Forty-three of these (17%) were recurrences referred from other centers. Mean BMI was 32.1 kg/m (range 20-59.4 kg/m). Mean defect width was 9.2 ± 4.2 cm (range 2.5-24.2 cm). Mean mesh size was 752 cm (range 150-1760 cm). Some form of abdominoplasty was performed in 59% of cases. Mean postoperative stay was 6.3 days (range 1-33 days). Mean follow-up time was 75 months (range 44-104 months). Fifty-three patients (21.1%) developed postoperative complications. Three (1.2%) developed superficial skin necrosis and 27 (10.8%) a superficial wound infection, but none developed deep mesh infection. Twelve (4.8%) developed symptomatic seroma and 11 (4.4%) a hematoma requiring surgical intervention. Seven (2.8%) patients developed recurrence within the follow-up period.
Peritoneal flap hernioplasty is an excellent and versatile method for reconstruction of large ventral hernias arising in both midline and transverse incisions. The technique is safe and associated with few complications and a very low recurrence rate.
当无法实现原发性筋膜闭合时，修复大型腹侧疝具有挑战性。腹膜瓣修补术是 Rives-Stoppa 肌后网片修补术的一种改良，通过使用疝囊来桥接筋膜间隙，并将网片与腹腔内容物和皮下空间隔离，从而解决了这个问题。它适用于中线和横切口疝。我们根据在苏格兰东南部爱丁堡地区进行的前瞻性维护的计算机数据库 Lothian 手术审核系统，回顾性分析了 251 例接受腹膜瓣修补术的患者的结果。从医院病历中获得患者的人口统计学、临床表现、疝的位置和手术治疗等信息。随访包括术后 3 个月的临床会诊和 2018 年 12 月完成的患者病历回顾。出现并发症迹象的患者在临床复查期间进行评估。
251 例患者接受了切口疝修补术，68.1%在中线，31.9%通过横切口。其中 43 例（17%）为来自其他中心的复发。平均 BMI 为 32.1kg/m（范围 20-59.4kg/m）。平均缺损宽度为 9.2±4.2cm（范围 2.5-24.2cm）。平均网片大小为 752cm（范围 150-1760cm）。59%的病例中进行了某种形式的腹部整形术。平均术后住院时间为 6.3 天（范围 1-33 天）。平均随访时间为 75 个月（范围 44-104 个月）。53 例（21.1%）发生术后并发症。3 例（1.2%）发生浅表皮肤坏死，27 例（10.8%）发生浅表伤口感染，但均未发生深部网片感染。12 例（4.8%）发生症状性血清肿，11 例（4.4%）发生血肿需手术干预。7 例（2.8%）患者在随访期间复发。
腹膜瓣修补术是一种出色且多功能的方法，适用于中线和横切口的大型腹侧疝的重建。该技术安全，并发症少，复发率低。
