Ramachandran C S
Department of Surgery, Sir Ganga Ram Hospital, J.K. Hospital and Surgical Centre, New Delhi, India.
Int Surg. 1998 Apr-Jun;83(2):171-3.
Pre-existing fascial umbilical defects may compound problems faced during laparoscopic surgery. Detection helps in preventing bowel or omental injury and repair can be done at the same time. Postoperative port incisional hernias are not uncommon and require surgical repair.
The incidence, clinical features and management of such fascial defects were studied in 2100 patients undergoing abdominal laparoscopy.
The incidence of fascial defects was 18%. The hernias were symptomatic in 56.5% cases, with an overwhelming female preponderance. A supra-umbilical incision above the upper limit of the hernia was used to establish the umbilical port and through this the hernias were repaired with nonabsorbable sutures. Postoperative incisional hernias occurred in 41 patients out of a total follow-up of 1892 cases (2.16%). The common predisposing factors were wound infection, postoperative chest infection and previous existing diseases, like diabetes and connective tissue disorders. Twenty-eight patients underwent mesh plasty and 3 cases had laparoscopic Gortex mesh repair. The remaining 10 cases refused surgery.
Omental fascial defects should be dealt with at the same sitting through a supra-umbilical port incision avoiding direct entry into the hernia. Use of nonabsorbable sutures is recommended. Prevention of wound infection and postoperative chest infection greatly reduces the chances of an incisional hernia.
预先存在的脐部筋膜缺损可能会使腹腔镜手术中面临的问题复杂化。检测有助于预防肠管或网膜损伤，并且可同时进行修复。术后切口疝并不少见，需要手术修复。
对2100例行腹部腹腔镜手术的患者，研究此类筋膜缺损的发生率、临床特征及处理方法。
筋膜缺损的发生率为18%。56.5%的病例中疝有症状，女性占绝大多数。在疝上限上方做脐上切口以建立脐部端口，通过此切口用不可吸收缝线修复疝。在1892例总随访病例中，41例发生术后切口疝（2.16%）。常见的易感因素为伤口感染、术后肺部感染以及既往存在的疾病，如糖尿病和结缔组织病。28例患者接受了补片修补术，3例进行了腹腔镜戈尔特斯补片修复术。其余10例拒绝手术。
网膜筋膜缺损应通过脐上端口切口在同一次手术中处理，避免直接进入疝囊。建议使用不可吸收缝线。预防伤口感染和术后肺部感染可大大降低切口疝的发生几率。
