Fukuda Rintaro, Tsujinaka Shingo, Maemoto Ryo, Takenami Tsutomu, Toyama Nobuyuki, Rikiyama Toshiki
Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Int J Surg Case Rep. 2019;60:148-151. doi: 10.1016/j.ijscr.2019.06.005. Epub 2019 Jun 12.
Incisional hernia (IH) is a common postoperative complication that affects 10% of the patients who undergo abdominal surgery. The component separation (CS) technique is suitable for large and/or complex hernias; however, CS alone may not eliminate recurrence and is associated with an increased incidence of wound complications. Self-gripping mesh enhances tissue adhesion and contributes to a reduced risk of migration, chronic pain, and other complications. Here, we present three cases of IH that were successfully repaired by anterior CS (ACS) using onlay self-gripping meshes.
All three patients underwent surgery using the following technique: Briefly, a skin flap was created with release of the external oblique muscle and preservation of the perforating vessels. The linea alba was closed with absorbable interrupted sutures. A self-gripping mesh was trimmed and placed with a 4-5 cm overlap bilaterally from the closed linea alba using an onlay technique. For all patients, the postoperative courses were uneventful and there were no complications at the 3-month follow-up.
The advantages of our technique include more sufficient abdominal reinforcement, technical simplicity, and minimal time required for mesh placement. The disadvantages are the potential risk of decreased blood flow of the skin flaps, wound infection, intestinal fistula, persisting or chronic pain, and difficulty with subsequent abdominal surgery.
The use of self-gripping mesh with ACS can be performed without increasing the operative time or causing short-term surgical complications. This technique may be recommended for large IH because of its simplicity and secure abdominal reinforcement provided.
切口疝（IH）是一种常见的术后并发症，腹部手术患者中有10%会受到影响。组织分离（CS）技术适用于大型和/或复杂疝；然而，单纯的CS可能无法消除复发，且与伤口并发症发生率增加有关。自固定补片可增强组织粘连，并有助于降低移位、慢性疼痛及其他并发症的风险。在此，我们介绍三例通过前路组织分离（ACS）并使用覆盖式自固定补片成功修复的切口疝病例。
所有三名患者均采用以下技术进行手术：简要来说，掀起皮瓣，松解腹外斜肌并保留穿支血管。用可吸收间断缝线关闭白线。修剪一片自固定补片，采用覆盖技术从已关闭的白线双侧重叠4 - 5厘米放置。对所有患者而言，术后病程顺利，3个月随访时无并发症。
我们技术的优点包括腹部加固更充分、技术简单以及放置补片所需时间最短。缺点是皮瓣血流减少、伤口感染、肠瘘、持续性或慢性疼痛的潜在风险，以及后续腹部手术困难。
使用自固定补片结合ACS进行手术不会增加手术时间或导致短期手术并发症。由于其操作简单且能提供可靠的腹部加固，该技术可推荐用于大型切口疝。
