Department of Surgery, Wolfson Medical Center, Holon, Israel.
Department of Surgery, Tel Aviv Medical Center, Ichilov Hospital, Tel Aviv, Israel.
Am Surg. 2023 Nov;89(11):4616-4624. doi: 10.1177/00031348221114027. Epub 2022 Sep 6.
Major abdominal wall defects remain a highly morbid complication. Occasionally a fascial defect is encountered, that despite all surgical efforts, is unable to completely approximate at the midline. Here we describe our method and outcomes of using a bridging mesh when the posterior fascia was unable to be approximated during the repair of large postoperative ventral hernias using the modified Rives-Stoppa technique.
A retrospective review was conducted looking at all the open abdominal wall hernia repairs between 2014 and 2020. The cohort of patients who had a bridge placed in addition to the traditional open modified Rives-Stoppa repair were used for this study.
Nineteen patients had a mesh inlay bridge placed in addition to a modified Rives-Stoppa repair with a sublay (retrorectus) Ultrapro mesh. For the inlay mesh 13 Symbotex composite meshes were placed and 6 Vicryl meshes used. The average surface area of the defect was 358.1 cm^2. The average length of hospitalization was 8.8 days with a range of 3-24 days. During the immediate postoperative course there were 6 minor complications. During the follow-up period there were 2 recurrences.
The use of inlay mesh bridge as an adjuvant to a modified Rives-Stoppa repair with a sublay ultrapro mesh is an effective technique for difficult abdominal wall repairs where the posterior fascia is unable to be approximated without tension.
腹部大的腹壁缺损仍然是一种高度病态的并发症。偶尔会遇到筋膜缺损，尽管进行了所有的手术努力，但仍无法在中线完全接近。在这里，我们描述了在使用改良的 Rives-Stoppa 技术修复大型术后腹疝时，如果后筋膜无法在修复时完全接近，我们使用桥接网片的方法和结果。
回顾性研究了 2014 年至 2020 年期间所有开放腹壁疝修复。本研究使用了在传统的开放式改良 Rives-Stoppa 修复中额外放置桥接网片的患者队列。
19 例患者在改良的 Rives-Stoppa 修复中额外放置了网片桥接，使用的是下网片（Retrorectus）Ultrapro 网片。对于嵌入式网片，放置了 13 个 Symbotex 复合网片和 6 个 Vicryl 网片。缺损的平均表面积为 358.1cm^2。平均住院时间为 8.8 天，范围为 3-24 天。在术后早期有 6 例轻微并发症。在随访期间有 2 例复发。
在使用下网片 Ultrapro 网片的改良 Rives-Stoppa 修复中，使用嵌入式网片桥接作为辅助手段，是一种有效的技术，适用于在没有张力的情况下无法接近后筋膜的困难腹壁修复。
