Lichtenstein I L, Shulman A G
Int Surg. 1986 Jan-Mar;71(1):1-4.
In 1985, Medicare started an experimental study in California mandating "Same-day" herniorrhaphy for all patients unless serious medical contraindication existed. Blue Shield and Blue Cross are rapidly following suit. It is little wonder therefore that ambulatory outpatient surgi-centers are now including hernia repair in their armamentarium. Change in environmental milieu must not compromise the quality of the surgery and care of the patient. This paper reviews the author's experience with outpatient hernia surgery and introduces a new surgical concept, tension-free repair. Since the first true herniorrhaphy was performed by Bassini over 100 years ago, all modifications and surgical techniques have shared a common disadvantage-suture line tension. This is the prime etiologic factor behind hernia recurrence. By using modern mesh prosthetics, it is now possible to repair all hernias without distortion of normal anatomy and with no suture line tension. The technique is simple, rapid, less painful, and effective; allowing prompt resumption of unrestricted physical activity.
1985年，医疗保险在加利福尼亚州启动了一项实验性研究，规定除非存在严重的医学禁忌证，否则所有患者均需接受“当日”疝修补术。蓝盾和蓝十字保险公司也在迅速效仿。因此，门诊手术中心现在将疝修补术纳入其医疗手段也就不足为奇了。环境的变化绝不能影响手术质量和患者护理。本文回顾了作者在门诊疝手术方面的经验，并介绍了一种新的手术概念——无张力修补术。自100多年前巴西尼首次进行真正的疝修补术以来，所有的改良方法和手术技术都有一个共同的缺点——缝合线张力。这是疝复发背后的主要病因。通过使用现代网状假体，现在可以修复所有疝，而不会扭曲正常解剖结构，也不会产生缝合线张力。该技术简单、快速、疼痛少且有效；能使患者迅速恢复不受限制的体力活动。
