Trupka A W, Hallfeldt K K, Schmidbauer S, Schweiberer L
Chirurgische Klinik und Poliklinik, Ludwig-Maximilians-Universität, München.
Chirurg. 1998 Jul;69(7):766-72. doi: 10.1007/s001040050488.
Incisional hernia repair with conventional techniques (simple closure, Mayo-technique) is associated with unacceptable recurrence rates of 30-50%. Therefore, surgical repair using different prosthetic biomaterials is becoming increasingly popular. Further to favourable results by French hernia surgeons, we studied the results of underlay prosthetic mesh repair using polypropylene mesh in complicated and recurrent incisional hernias.
After preparation and excision of the entire hernia sac, the posterior rectus sheath is freed from the muscle bellies on both sides. The peritoneum and posterior rectus sheaths are closed with a continuous looped polyglyconate suture. The prosthesis used for midline hernias is positioned on the posterior rectus sheath and extends far beyond the borders of the myoaponeurotic defect. The anterior rectus sheath is closed with a continuous suture. The prosthesis for lumbar and subcostal hernias is placed in a prepared space between the transverse and oblique muscles. Intraperitoneal placement of the mesh must be avoided.
Between January 1996 and August 1997 we performed a total of 33 incisional hernia repairs (14 primary hernias, 19 recurrent hernias) using this technique (16 women, 17 men, mean age 56.19 +/- 12.92 years). Local complications occurred in four patients (12%): superficial wound infection (n = 2), postoperative bleeding, requiring reoperation (n = 1), minor hemato-seroma (n = 1). One patient suddenly died on the 3rd post-operative day from severe pulmonary embolism (mortality 3%). Twenty-two patients with a minimum follow up to 6 months were re-examined clinically. The average follow-up time for this group was 9 months (range 6-17 months). To date no recurrent hernias have been observed. There were only minor complaints like "a feeling of tension" in the abdominal wall (n = 3) and slight pain under physical stress (n = 6).
The use of prosthetic mesh should be considered for repair of large or recurrent incisional hernias, especially in high-risk patients (obesity, obstructive lung disease) and complicated hernias. The aforementioned technique of underlay prosthetic repair using polypropylene mesh fixed onto the posterior rectus sheath allows for anatomical and consolidated reconstruction of the damaged abdominal wall with excellent results and low complication rates.
采用传统技术（单纯缝合、梅奥技术）进行切口疝修补，复发率高达30% - 50%，令人难以接受。因此，使用不同人工生物材料进行手术修补越来越普遍。继法国疝外科医生取得良好效果之后，我们研究了在复杂和复发性切口疝中使用聚丙烯网片进行补片修补的效果。
在准备并切除整个疝囊后，从两侧的肌腹游离腹直肌后鞘。用连续环形聚乙醇酸缝线缝合腹膜和腹直肌后鞘。用于中线疝的假体置于腹直肌后鞘上，并延伸至远远超出肌-腱膜缺损的边界。用连续缝线缝合腹直肌前鞘。用于腰疝和肋下疝的假体置于腹横肌和腹内斜肌之间的准备好的间隙中。必须避免网片置于腹腔内。
在1996年1月至1997年8月期间，我们使用该技术共进行了33例切口疝修补术（14例原发性疝，19例复发性疝）（16例女性，17例男性，平均年龄56.19±12.92岁）。4例患者（12%）出现局部并发症：浅表伤口感染（2例）、术后出血需再次手术（1例）、少量血肿-血清肿（1例）。1例患者在术后第3天因严重肺栓塞突然死亡（死亡率3%）。对22例至少随访6个月的患者进行了临床复查。该组患者的平均随访时间为9个月（范围6 - 17个月）。迄今为止，未观察到复发性疝。仅有轻微不适，如腹壁“紧绷感”（3例）和身体受压时轻微疼痛（6例）。
对于大型或复发性切口疝修补，尤其是高危患者（肥胖、阻塞性肺病）和复杂疝患者，应考虑使用人工网片。上述使用固定在腹直肌后鞘上的聚丙烯网片进行补片修补的技术，能够对受损腹壁进行解剖学和稳固的重建，效果良好且并发症发生率低。
