Costanza M J, Heniford B T, Arca M J, Mayes J T, Gagner M
Department of Surgery, Minimally Invasive Surgery Center, Cleveland Clinic Foundation, Ohio, USA.
Am Surg. 1998 Dec;64(12):1121-5; discussion 1126-7.
Break down after repair of recurrent ventral hernias can exceed 50 per cent. Laparoscopic techniques offer an alternative. This study evaluated the efficacy of the laparoscopic approach for recurrent ventral hernias. A retrospective review on all patients with a recurrent ventral hernia who underwent laparoscopic repair at our institution from August 1995 to June 1997 was performed. Demographic, operative, postoperative, and follow-up data were collected. Thirty-one patients underwent an attempted laparoscopic ventral hernia repair. Sixteen were for recurrent hernias; 15 were successfully repaired laparoscopically. The patients were typically obese (mean body mass index, 30 kg/m2), had an average of 2.4 previous open repairs (range, 1-7), and six patients had previously placed intra-abdominal mesh. An average of 3.5 (range, 1-16) defects were found per patient with a mean total hernia size of 130 cm2 (6-480 cm2). In all cases, expanded polytetrafluoroethylene mesh (average, 299 cm2) was secured with transabdominal sutures. Postoperatively patients required an average of 19 mg of narcotics (MSO4 equivalent). Bowel function returned in 1.7 days. Length of stay averaged 2.0 days (1-4 days). There were two complications: cellulitis, which resolved with antibiotics, and skin break-down, which required mesh removal. With follow-up averaging 18 months (7-29 months), there is one recurrence; the case in which the mesh was removed. Laparoscopic repair of recurrent ventral hernia seems promising. Decreased hospital stays, postoperative pain, wound complications, and a low rate of recurrence are benefits of this technique.
复发性腹疝修补术后的复发率可能超过50%。腹腔镜技术提供了一种替代方法。本研究评估了腹腔镜治疗复发性腹疝的疗效。对1995年8月至1997年6月在我院接受腹腔镜修补术的所有复发性腹疝患者进行了回顾性研究。收集了人口统计学、手术、术后及随访数据。31例患者尝试进行腹腔镜腹疝修补术。其中16例为复发性疝；15例成功进行了腹腔镜修补。患者通常肥胖（平均体重指数为30kg/m²），平均曾接受过2.4次开放性修补术（范围为1 - 7次），6例患者曾植入过腹腔内补片。每位患者平均发现3.5个（范围为1 - 16个）缺损，平均总疝面积为130cm²（6 - 480cm²）。在所有病例中，使用经腹缝线固定膨体聚四氟乙烯补片（平均面积为299cm²）。术后患者平均需要19mg麻醉剂（以硫酸吗啡当量计）。肠道功能在1.7天恢复。住院时间平均为2.0天（1 - 4天）。有2例并发症：蜂窝织炎经抗生素治疗后缓解，皮肤破溃需取出补片。随访平均18个月（7 - 29个月），有1例复发；为取出补片的病例。腹腔镜修补复发性腹疝似乎很有前景。缩短住院时间、减轻术后疼痛、减少伤口并发症以及低复发率是该技术的优点。
