AP-HP, Department of Digestive, Oncologic and Metabolic Surgery, Ambroise Paré Hospital, Boulogne-Billancourt, France.
Versailles St-Quentin-en-Yvelines/Paris Saclay University, UFR des sciences de la santé Simone Veil, 78180, Montigny-le-Bretonneux, France.
World J Surg. 2020 Jun;44(6):1762-1770. doi: 10.1007/s00268-020-05395-4.
Incisional hernia (IH) may occur in 20% of patients after laparotomy. The hernia sac volume may be of significance, with reintegration of visceral contents potentially leading to repair failure or abdominal compartment syndrome. The present study aimed to evaluate a two-step surgical strategy comprising right colectomy for hernia reduction with synchronous absorbable mesh repair followed by definitive non-absorbable mesh repair in recurrence.
Patients operated between 2012 and 2017 at two university centers were retrospectively included. Volumetric evaluation of the IH was performed by CT imaging.
Eleven patients were included. The mean BMI was 43 kg/m (23-52 kg/m). Progressive preoperative pneumoperitoneum was performed in 82% of patients, with complications in 22%. The mean volumetric ratio of the volume of the hernia to the volume of the abdominal cavity was 70% (48-100%). The first parietal repair was performed using an synthetic absorbable mesh (36%), a biologic mesh (27%), or a slowly absorbable mesh (36%). No patients died as a result of the procedure. Seven (64%) patients developed grade III-IV complications, including one case of an anastomotic fistula. Recurrence occurred in eight (73%) patients after the first repair. Of these, four (50%) patients were reoperated using a non-absorbable mesh, leading to solid repair in 75% of cases. After 27 ± 18 months of follow-up, the residual IH rate was 46%.
Right colectomy for volume reduction in IH with loss of domain potentially represents an appropriate salvage option, supporting bowel reintegration and temporary hernia repair with absorbable material.
剖腹术后切口疝（IH）的发生率约为 20%。疝囊体积可能具有重要意义，内脏内容物的重新整合可能导致修复失败或腹腔室隔综合征。本研究旨在评估一种两步手术策略，包括右半结肠切除术以减少疝的体积，同时使用可吸收网片进行同步修复，然后在复发时进行确定性不可吸收网片修复。
回顾性纳入 2012 年至 2017 年在两个大学中心接受手术的患者。通过 CT 成像对 IH 进行容积评估。
共纳入 11 例患者。平均 BMI 为 43kg/m（23-52kg/m）。82%的患者进行了术前逐渐增加的气腹，并发症发生率为 22%。IH 体积与腹腔体积的比值平均为 70%（48-100%）。首次修补采用合成可吸收网片（36%）、生物网片（27%）或缓慢可吸收网片（36%）。没有患者因手术死亡。7（64%）例患者发生 III-IV 级并发症，包括 1 例吻合口瘘。首次修复后 8（73%）例患者复发。其中 4（50%）例患者再次接受不可吸收网片修复，75%的病例获得了确定性修复。在 27±18 个月的随访后，残余 IH 率为 46%。
对于 IH 体积减少和功能丧失的患者，右半结肠切除术可能是一种合适的挽救选择，支持肠重新整合，并使用可吸收材料进行临时疝修复。
