Division of Gastrointestinal and Minimally Invasive Surgery, Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA.
Department of Surgery, University of FL Health-Jacksonville, Jacksonville, FL, USA.
Langenbecks Arch Surg. 2023 Jan 24;408(1):60. doi: 10.1007/s00423-023-02811-w.
Open ventral hernia repair is one of the most common operations performed by general surgeons. Appropriate patient selection and preoperative optimization are important to ensure high-quality outcomes and prevent hernia recurrence. Preoperative adjuncts such as the injection of botulinum toxin and progressive preoperative pneumoperitoneum are proven to help achieve fascial closure in patients with hernia defects and/or loss of domain. Operatively, component separation techniques are performed on complex hernias in order to medialize the rectus fascia and achieve a tension-free closure. Other important principles of hernia repair include complete reduction of the hernia sac, wide mesh overlap, and techniques to control seroma and other wound complications. In the setting of contamination, a delayed primary closure of the skin and subcutaneous tissues should be considered to minimize the chance of postoperative wound complications. Ultimately, the aim for hernia surgeons is to mitigate complications and provide a durable repair while improving patient quality of life.
开放式腹疝修补术是普通外科医生最常进行的手术之一。适当的患者选择和术前优化对于确保高质量的手术结果和预防疝复发至关重要。术前辅助手段，如肉毒毒素注射和渐进性术前气腹，已被证明有助于在有疝缺损和/或域丢失的患者中实现筋膜闭合。在手术中，对于复杂疝，采用了组件分离技术，以使腹直肌筋膜向内侧化，并实现无张力闭合。疝修复的其他重要原则包括疝囊的完全复位、网片的广泛重叠，以及控制血清肿和其他伤口并发症的技术。在污染的情况下，应考虑延迟一期缝合皮肤和皮下组织，以最大程度地减少术后伤口并发症的机会。最终，疝外科医生的目标是减轻并发症，提供持久的修复，并改善患者的生活质量。
