Robin Valle de Lersundi Alvaro, Munoz-Rodriguez Joaquín, Lopez-Monclus Javier, Blazquez Hernando Luis Alberto, San Miguel Carlos, Minaya Ana, Perez-Flecha Marina, Garcia-Urena Miguel Angel
Hospital Universitario del Henares, Madrid, Spain.
Universidad Francisco de Vitoria, Madrid, Spain.
Front Surg. 2021 Jan 8;7:611308. doi: 10.3389/fsurg.2020.611308. eCollection 2020.
The aim of this study is to describe the macroscopic features and histologic details observed after retromuscular abdominal wall reconstruction with the combination of an absorbable mesh and a permanent mesh. We have considered all patients that underwent abdominal wall reconstruction (AWR) with the combination of two meshes that required to be reoperated for any reason. Data was extracted from a prospective multicenter study from 2012 to 2019. Macroscopic evaluation of parietal adhesions and histological analysis were carried out in this group of patients. Among 466 patients with AWR, we identified 26 patients that underwent a reoperation after abdominal wall reconstruction using absorbable and permanent mesh. In eight patients, the reoperation was related to abdominal wall issues: four patients were reoperated due to recurrence, three patients required an operation for chronic mesh infection and one patient for symptomatic bulging. A miscellanea of pathologies was the cause for reoperation in 18 patients. During the second surgical procedures made after a minimum of 3 months follow-up, a fibrous tissue between the permanent mesh covering and protecting the peritoneum was identified. This fibrous tissue facilitated blunt dissection between the permanent material and the peritoneum. Samples of this tissue were obtained for histological examination. No case of severe adhesions to the abdominal wall was seen. In four cases, the reoperation could be carried out laparoscopically with minimal adhesions from the previous procedure. The reoperations performed after the combination of absorbable and permanent meshes have shown that the absorbable mesh acts as a protective barrier and is replaced by a fibrous layer rich in collagen. In the cases requiring new hernia repair, the layer between peritoneum and permanent mesh could be dissected without special difficulty. Few intraperitoneal adhesions to the abdominal wall were observed, mainly filmy, easy to detach, facilitating reoperations.
本研究的目的是描述在使用可吸收网片和永久性网片联合进行肌后腹壁重建后观察到的宏观特征和组织学细节。我们纳入了所有因任何原因需要再次手术而接受了两种网片联合腹壁重建（AWR）的患者。数据取自2012年至2019年的一项前瞻性多中心研究。对该组患者进行了腹壁粘连的宏观评估和组织学分析。在466例接受AWR的患者中，我们确定了26例在使用可吸收和永久性网片进行腹壁重建后接受再次手术的患者。在8例患者中，再次手术与腹壁问题有关：4例因复发接受再次手术，3例因慢性网片感染需要手术，1例因有症状的膨出接受手术。18例患者再次手术的原因是各种病理情况。在至少随访3个月后进行的第二次手术过程中，在覆盖和保护腹膜的永久性网片之间发现了纤维组织。这种纤维组织便于在永久性材料和腹膜之间进行钝性分离。获取该组织的样本进行组织学检查。未发现与腹壁严重粘连的病例。在4例病例中，可以通过腹腔镜进行再次手术，与上次手术的粘连极少。可吸收和永久性网片联合使用后进行的再次手术表明，可吸收网片起到了保护屏障的作用，并被富含胶原蛋白的纤维层所取代。在需要进行新的疝修补的病例中，腹膜和永久性网片之间的层可以很容易地分离。观察到很少有与腹壁的腹腔内粘连，主要是薄膜状的，易于分离，便于再次手术。
