Sikar Hasan Ediz, Çetin Kenan
Department of General Surgery, Dr. Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
Wideochir Inne Tech Maloinwazyjne. 2019 Sep;14(3):366-373. doi: 10.5114/wiitm.2019.85350. Epub 2019 May 23.
Recurrent hernias can be treated by laparoscopy without the need for mesh removal. However, shrinkage of the mesh following recurrence affects most of the patients, and leaving a partially floating and rigid foreign body could be discussed.
To compare the outcomes of patients regarding the removal of previous mesh during laparoscopic repair of recurrent abdominal wall hernias.
Patients who underwent laparoscopic repair for recurrent ventral hernias between August 2012 and March 2015 were included in the study. The patients with complete removal of the mesh were included in the MR group and the patients with partial removal or without removal of the previous mesh were included in the non-MR group. Patient characteristics and demographics, previous hernia repair, defect size, mesh size, operative time, mean hospital stay, complications, recurrences, numeric pain rating scale (NRS), early termination of analgesics and prolonged use of analgesics were compared.
A total of 112 patients with a mean age of 53.2 and mean body mass index of 31.1 kg/m underwent laparoscopic repair. There were 47 patients in the MR group and 54 patients in the non-MR group. Operative time was shorter in the non-MR group (p < 0.05), whereas symptomatic seroma and NRS scores on postoperative day 10 and at the 6 week were higher in comparison with the MR group (p < 0.05).
Mesh removal during laparoscopic repair of recurrent ventral hernias has an association with the reduction of pain and symptomatic seroma. However, further prospective comparative studies are required to verify this view.
复发性疝可通过腹腔镜治疗，无需移除补片。然而，复发后补片收缩影响大多数患者，且遗留部分漂浮且坚硬的异物这一情况值得探讨。
比较复发性腹壁疝腹腔镜修补术中移除既往补片与未移除补片患者的治疗效果。
纳入2012年8月至2015年3月期间接受腹腔镜复发性腹疝修补术的患者。补片完全移除的患者纳入MR组，既往补片部分移除或未移除的患者纳入非MR组。比较患者的特征和人口统计学资料、既往疝修补情况、缺损大小、补片大小、手术时间、平均住院时间、并发症、复发情况、数字疼痛评分量表（NRS）评分、镇痛药物提前停用情况以及镇痛药物长期使用情况。
共有112例平均年龄53.2岁、平均体重指数31.1kg/m²的患者接受了腹腔镜修补术。MR组有47例患者，非MR组有54例患者。非MR组手术时间较短（p<0.05），而与MR组相比，术后第10天和6周时症状性血清肿和NRS评分较高（p<0.05）。
腹腔镜复发性腹疝修补术中移除补片与疼痛减轻和症状性血清肿减少有关。然而，需要进一步的前瞻性对照研究来验证这一观点。
