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1.
Adult umbilical and paraumbilical hernia repair is associated with a high recurrence rate of 10–30%. Mesh repair has been
reported to be associated with low recurrence rates. This study aims to compare sutured repair with prosthetic mesh repair
to evaluate recurrence and infection rates. A retrospective study was conducted over an 8-year period including all the umbilical
and paraumbilical hernia repairs performed by one consultant surgeon. The hernias were repaired using interrupted suture,
Mayo overlap, flat mesh and mesh plug techniques. The study was based on case-note review, telephone and postal questionnaire
survey. A total of 100 patients were studied, of which 70 had paraumbilical hernias, 28 had umbilical hernias and 2 had both
types of hernia. Median age was 56 years (range 19–90 years). A total of 61 patients had suture repair (50 interrupted suture
repair, 11 Mayo) and 39 had prosthetic mesh repair (33 mesh plug, 6 flat mesh). The median body mass index (BMI) was 31.2
(range 23.4–44.5) in the suture repair group and 33.3 (range 24.1–59.1) in the mesh group, with no significant statistical
difference in BMI between the two groups (P>0.05). Median follow-up was 4.5 years (range 1–8 years). Recurrence rates for the suture and mesh repair groups were 11.5
and 0%, respectively (P=0.007). Infection rates for the suture and mesh repair groups were 11.5 and 0%, respectively (P=0.007). Our data suggest that prosthetic mesh repair is ideal for managing primary and recurrent umbilical hernias in both
obese and non-obese patients.
This article was presented at the Association of surgeons of Great Britain and Ireland (ASGBI, April 2004 Harrogate) and 26th
International congress of European Hernia Society, Prague, April 2004). 相似文献
2.
Incisional hernia repair in Sweden 2002 总被引:5,自引:0,他引:5
Incisional hernia is a common problem after abdominal surgery. The complication and recurrence rates following the different
repair techniques are a matter of great concern. Our aim was to study the results of incisional hernia repair in Sweden. A
questionnaire was sent to all surgical departments in Sweden requesting data concerning incisional hernia repair performed
during the year 2002. Eight hundred and sixty-nine incisional hernia repairs were reported from 40 hospitals. Specialist surgeons
performed the repair in 782 (83.8%) patients. The incisional hernia was a recurrence in 148 (17.0%) patients. Thirty-three
per cent of the hernias were subsequent to transverse, subcostal or muscle-splitting incisions or laparoscopic procedures.
Suture repair was performed in 349 (40.2%) hernias. Onlay mesh repair was more common than a sublay technique. The rate of
wound infection was 9.6% after suture repair and 8.1% after mesh repair. The recurrence rate was 29.1% with suture repair,
19.3% with onlay mesh repair, and 7.3% with sublay mesh repair. This survey revealed that there is room for improvement regarding
the incisional hernia surgery in Sweden. Suture repair, with its unacceptable results, is common and mesh techniques employed
may not be optimal. This study has led to the instigation of a national incisional hernia register. 相似文献
3.
Background Incisional hernia is a serious complication after abdominal surgery and occurs in 11–23% of laparotomies. Repair can be done,
for instance, with a direct suture technique, but recurrence rates are high. Recent literature advises the use of mesh repair.
In contrast to this development, we studied the use of a direct suture repair in a separate layer technique. The objective
of this retrospective observational study is to assess the outcomes (recurrences and complications) of a two-layered open
closure repair for primary and recurrent midline incisional hernia without the use of mesh.
Methods In an observational retrospective cohort study, we analysed the hospital and outpatient records of 77 consecutive patients
who underwent surgery for a primary or recurrent incisional hernia between 1st May 2002 and 8th November 2006. The repair
consisted of separate continuous suturing of the anterior and posterior fascia, including the rectus muscle, after extensive
intra-abdominal adhesiolysis.
Results Forty-one men (53.2%) and 36 women (46.8%) underwent surgery. Sixty-three operations (81.8%) were primary repairs and 14 (18.2%)
were repairs for a recurrent incisional hernia. Of the 66 patients, on physical examination, three had a recurrence (4.5%)
after an average follow-up of 2.6 years. The 30-day postoperative mortality was 1.1%. Wound infection was seen in five patients
(6.5%).
Conclusions A two-layered suture repair for primary and recurrent incisional hernia repair without mesh with extensive adhesiolysis was
associated with a recurrence rate comparable to mesh repair and had an acceptable complication rate.
D. den Hartog and A.H.M. Dur contributed equally to this article. 相似文献
4.
5.
Factors affecting recurrence after incisional hernia repair 总被引:3,自引:0,他引:3
D. Vidović D. Jurišić B. D. Franjić E. Glavan M. Ledinsky M. Bekavac-Bešlin 《Hernia》2006,10(4):322-325
Incisional hernias occur primarily as a result of high tension and inadequate healing of a previous incision, the latter of
which is frequently related to infection at the surgical site. Despite recent advances in operative techniques, the recurrence
rate remains unacceptably high. To evaluate the impact of different predisposing factors for the recurrence of incisional
hernia, we reviewed retrospectively the medical records of 297 patients who had undergone incisional herniorrhaphy (188 tissue
repairs, 109 mesh repairs) in our hospital. Demographic data (age and gender), type of repair, body mass index, hernia size,
presence of chronic illnesses and wound complications were evaluated in a univariate and multivariate manner analysis. The
overall recurrence rate was 30.3%, with the recurrence rate in patients who underwent tissue repair being 39.4% and that
in patients following prosthetic repair 14.6%. The recurrence rate was significantly influenced by type of repair, obesity,
hernia size, wound healing disorders and some chronic comorbidities. We conclude that it is necessary to become familar with
the risk factors for recurrence of incisional hernia in order to eliminate or decrease their effect on the positive outcome
of incisional herniorrhaphy. 相似文献
6.
Incisional hernia—comparison of mesh repair with Cardiff repair: an university hospital experience 总被引:1,自引:0,他引:1
Background: Incisional hernia is a frequent complication of abdominal surgery. Various types of repair are recommended for incisional
hernia. Suture and mesh repair are compared in the present study. Method: One hundred seventy one patients with incisional hernia underwent Cardiff repair (far and near sutures with reinforcement
sutures) which was used as an open suture repair while onlay polypropylene mesh was used in the mesh repair technique. Result: Cardiff repair was performed in 116 patients with no mortality with recurrence in two patients with mean follow up of 7.1 years.
Both these patients with recurrence had a defect measuring more than 10 cm in width. Mesh repair was carried out in 55 patients
with no recurrence in mean follow up of 37 months. Seroma formation was noted in 7 (12.72%) with mesh repair as compared to
4 (3.44%) patients with Cardiff repair. Conclusion: We recommend Cardiff repair for primary and small to medium size incisional hernias. Onlay polypropylene mesh is ideal for
tension-free hernia repair, recurrent incisional hernia and hernia defects wider than 10 cm. 相似文献
7.
Laparoscopic versus open ventral hernia mesh repair: a prospective study 总被引:15,自引:4,他引:11
Background An incisional hernia develops in 3% to 13% of laparotomy incisions, with primary suture repair of ventral hernias yielding
unsatisfactory results. The introduction of a prosthetic mesh to ensure abdominal wall strength without tension has decreased
the recurrence rate, but open repair requires significant soft tissue dissection in tissues that are already of poor quality
as well as flap creation, increasing complication rates and affecting the recurrence rate. A minimally invasive approach was
applied to the repair pf ventral hernias, with the expectation of earlier recovery, fewer postoperative complications, and
decreased recurrence rates. This prospective study was performed to objectively analyze and compare the outcomes after open
and laparoscopic ventral hernia repair.
Methods The outcomes for 50 unselected patients who underwent laparoscopic ventral hernia repair were compared with those for 50 consecutive
unselected patients who underwent open repair. The open surgical operations were performed by the Rives and Stoppa technique
using prosthetic mesh, whereas the laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair
technique in all cases.
Results The study group consisted of 100 patients (82 women and 18 men) with a mean age of 55.25 years (range, 30–83 years). The patients
in the two groups were comparable at baseline in terms of sex, presenting complaints, and comorbid conditions. The patients
in laparoscopic group had larger defects (93.96 vs 55.88 cm2; p = 0.0023). The mean follow-up time was 20.8 months (95% confidence interval [CI], 18.5640–23.0227 months). The mean surgery
durations were 90.6 min for the laparoscopic repair and 93.3 min for the open repair (p = 0.769, nonsignificant difference). The mean postoperative stay was shorter for the laparoscopic group than for the open
hernia group (2.7 vs 4.7 days; p = 0.044). The pain scores were similar in the two groups at 24 and 48 h, but significantly less at 72 h in the laparoscopic
group (mean visual analog scale score, 2.9412 vs 4.1702; p = 0.001). There were fewer complications (24%) and recurrences (2%) among the patients who underwent laparoscopic repair
than among those who had open repair (30% and 10%, respectively).
Conclusions The findings demonstrate that laparoscopic ventral hernia repair in our experience was safe and resulted in shorter operative
time, fewer complications, shorter hospital stays, and less recurrence. Hence, it should be considered as the procedure of
choice for ventral hernia repair. 相似文献
8.
Incisional hernia: challenge of re-operations after mesh repair 总被引:3,自引:0,他引:3
Joachim Conze Carsten J. Krones Volker Schumpelick Uwe Klinge 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(4):453-457
Background and aims The widespread use of meshes for the repair of incisional hernia is currently followed by an increasing number of re-operations.
The incidence of incisional hernia recurrence after mesh repair varies between 3 and 32%. The problem of mesh failure and
options for another surgical intervention seem rather unattended.
Methods We present our experience of 77 re-operations after previous mesh repair that were performed between 1995 and 2004 out of
a total of 1,070 operations for incisional hernia. The retrospective analysis focused on recurrence in relation to location,
material of the previous mesh repair and the surgical procedure to resolve the problem.
Results The locations of the preceding meshes were epifascial as onlays (n=23), retromuscular as sublays (n=46), within the defect as inlays (n=6) or intraperitoneally (n=2). The direction of the incision was vertical medial (n=41) or horizontal crossing the linea semilunaris (n=36). Recurrences after median incisional hernia mesh repair mainly occurred at the cranial border of the mesh subxiphoidal.
Except for two patients, all recurrences manifested at the margin of the enclosed mesh.
Conclusions Re-operation after previous mesh repair is a surgical challenge. The type of revision procedure has to consider the position
and material of the previous mesh. In our clinic recurrences, heavyweight polypropylene meshes were mostly treated with mesh
exchange and lightweight polypropylene meshes could be treated by extension with a second mesh. In contrast to suture techniques,
deficient mesh repairs are more evidently related to technical problems. 相似文献
9.
Incisional hernia is a relatively common complication following abdominal operations. Due to high recurrence rates following
primary suture, a prosthetic mesh is now usually used to repair the hernia. Several different types of repair are described.
A combined fascia and mesh technique avoids opening the peritoneal cavity and potential damage to bowel. This study describes
results of this technique. Consecutive patients undergoing the operation were contacted to assess freedom from recurrence
and satisfaction with results. Some 34 patients underwent 36 incisional repairs. Of the 34 patients 21 were men and 13 were
women with a median age of 69 years (range 31–86 years). The causative incisions were midline (30), Kochers (2), Pfannesteil
(2) and transverse (2). The median time spent in hospital was three nights (range 1–14 days). Two patients developed seromas,
another complained of pain soon after operation, one patient developed a superficial wound infection another developed a tender
drain site which required exploration. One patient with significant co-morbidity died 13 days postoperatively from multiorgan
failure. Freedom from recurrence of the hernia was 91% at 5 years. However patient survival was only 70% at 5 years. This
technique is associated with low postoperative morbidity and a low recurrence rate. Patients presenting with incisional hernias
have a poor long-term prognosis which needs to be borne in mind when planning intervention. 相似文献
10.
Riley K. Kitamura Jacqueline Choi Elizabeth Lynn Celia M. Divino 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2013,17(4):560-564
Background and Objectives:
Mesh fixation in laparoscopic umbilical hernia repair is poorly studied. We compared postoperative outcomes of laparoscopic umbilical hernia repair in suture versus tack mesh fixation.Methods:
Patients who underwent laparoscopic umbilical hernia repair were separated by method of mesh fixation: sutures versus primarily tacks. Medical history and follow-up data were collected through medical records. The primary outcome of this study was the recurrence rates of hernias. Postoperative major and minor complications, such as surgical site infection, small-bowel obstruction, and seroma formation, were regarded as secondary outcomes. Additionally, a telephone interview was conducted to assess postoperative pain, recovery time, and overall patient satisfaction.Results:
Eighty-six patients were identified: 33 in the suture group and 53 in the tacks group. The number of emergent cases was increased in the tacks group (6 vs 0; P = .022). Mean follow-up time was 2.7 years for both groups. Documented postoperative follow-up was obtained in 29 (90%) suture group and 31 (58%) tacks group patients. Hernia recurrence occurred in 3 and 2 patients in the sutures and tacks groups, respectively (P was not significant). No differences were found in secondary outcomes, including subjective outcomes from telephone interviews, between groups.Conclusions:
There are no differences in postoperative complication rates in suture versus tack mesh fixation in laparoscopic umbilical hernia repair. 相似文献11.
Asolati M Huerta S Sarosi G Harmon R Bell C Anthony T 《American journal of surgery》2006,192(5):627-630
BACKGROUND: Different medical and social conditions have been associated with primary and recurrent hernias. Possible predictors of recurrence after elective umbilical hernia repair have not been defined clearly. The aim of this study was to determine factors that predict recurrence in patients after elective repair of umbilical hernias. METHODS: A 6-year retrospective review of patients with elective umbilical hernia repair at the Dallas VA Medical Center was performed. Clinical and pathologic data were evaluated by univariate analysis to identify predictive factors for recurrence. RESULTS: A total of 244 patients underwent elective hernia repair within the study period (male, 96%; mean age, 56 y; Caucasian, 74%; African American, 14%; Hispanic, 8%). Because 15 patients were not compliant with follow-up requirements, 229 were eligible for the study. Ninety-seven underwent suture repair (42.4%) and 132 underwent mesh repair (57.3%). Eleven recurrences were identified (4.8%): 7 in the suture repair group (7.7%) and 4 in the mesh repair group (3%). Univariate analysis showed that patients likely to develop recurrences were as follows: African American (15.6% vs. 3.5%; P = .017), type II diabetics (14.2% vs. 2.6%; P = .002), patients with hyperlipidemia (9.2% vs. 2.6%; P = .028), and human immunodeficiency virus-positive patients (66.6% vs. 3.9%; P = .000). CONCLUSIONS: Smoking, obesity, size of hernia, type of repair, or chronic obstructive pulmonary disease do not seem to predict recurrence of hernias in our VA population. African Americans, patients with type II diabetes, hyperlipidemia, and positive for human immunodeficiency virus, may have a higher risk for recurrence after elective umbilical hernia repair. 相似文献
12.
The objective was to make a cost analysis of incisional hernia repair by suture repair or prosthetic mesh repair. The study
included 44 patients who underwent hernia repair between 1991 and 2000. The rate of recurrent incisional hernia after more
than 1 year with associated costs was registered. In 1996, the technique of incisional hernia repair was changed from suture
repair to mesh repair. With a mesh repair, zero out of 19 patients presented with a recurrence at follow-up, and with suture
repair, five out of 13 had a recurrence (P<0.01). The duration of anaesthetic and operation was longer, but stay in the surgical ward, and sick leave was shorter for
patients with a mesh repair than for those with a suture repair. For working patients, costs in the operating theatre were
4,095 Swedish kronor (SEK) higher with a mesh repair, and the costs for surgical ward, sick leave, and examination were 10,129
SEK lower than with a suture repair. Thus, with a mesh repair, the total costs were 6,034 SEK lower than with a suture repair.
For retired patients, the total costs with a mesh repair were 1,898 SEK lower than with a suture repair. We conclude that
in this setting, mesh repair of incisional hernias produced lower costs than suture repair. 相似文献
13.
Primary incisional hernia repair with or without polypropylene mesh: a report on 384 patients with 5-year follow-up 总被引:6,自引:1,他引:5
Background and aim Several studies have claimed that mesh repair of incisional hernia lowers recurrence rates when compared to suture repair. We investigated the relative effectiveness of mesh and suture repair in a large homogeneous cohort of patients with primary incisional hernia.Patients and methods In a retrospective single-centre cohort study, a total of 446 consecutive patients were identified, of whom 86% could be followed up. Mean length of follow-up was 5 years. In 79 patients (22%), we implanted a mesh, usually polypropylene (Prolene).Results Compared to suture repair, mesh repair prolonged operating time by over 30 min and caused seroma in 12.7% of the patients (p<0.001). Only 4 of the 79 patients with mesh repair developed recurrence, compared to 55 of the 305 patients with suture repair (5 vs 18%, p=0.02 by log-rank test). In multivariate Cox regression, recurrence rates were fourfold higher after suture than after mesh repair (p=0.02). Interestingly, old age was associated with a decreased susceptibility for recurrence (p=0.01).Conclusion Our data confirms the long-term effectiveness of mesh repair under routine conditions. Suture repair should be restricted to small hernias in patients free of known risk factors. 相似文献
14.
Objective The aim of this study was to audit the results of parastomal hernia repair. Methods A retrospective review was made of all patients having parastomal hernia repair at 2 teaching hospitals over a 12‐year period. Results Forty‐three patients had 51 parastomal hernia repairs. Three types of hernia repair were used: 14 (28%) local suture, 19 (37%) local mesh repair and 18 (35%) stoma relocation. Three patients died and significant complications occurred in 65% of repairs. Parastomal hernia recurred in 18 (38%) of repairs. This was greatest with a sutured repair (59%) and least in patients having stoma relocation (24%). Repair with mesh was associated with a 39% recurrence rate. No significant statistical difference was found for the results of these repairs. Conclusion Parastomal hernia repair is associated with high rates of morbidity, mortality and recurrence. Repair should not be undertaken without a good indication. 相似文献
15.
Randomized clinical trial comparing suture and mesh repair of umbilical hernia in adults 总被引:23,自引:0,他引:23
Arroyo A García P Pérez F Andreu J Candela F Calpena R 《The British journal of surgery》2001,88(10):1321-1323
BACKGROUND: Prosthetic repair has become the standard method for inguinal hernia and has excellent results. The question remains of whether the mesh technique could also improve results for umbilical defects. METHODS: The study was a randomized clinical trial comparing herniorrhaphy (primary suture) with hernioplasty (polypropylene mesh or plug) in 200 adult patients with a primary umbilical hernia. Patients at high anaesthetic risk (American Society of Anesthesiologists (ASA) grade IV) or those who needed emergency surgery were excluded. The mean postoperative follow-up was 64 months. The population studied included 118 women and 82 men with a mean age at presentation of 57 years. Some 173 patients were ASA grade I-II and 27 were ASA III. The anaesthetic technique of choice was local anaesthetic infiltration plus sedation (98 per cent). RESULTS: There were no significant anaesthetic complications or surgical deaths. The mean duration of surgery was greater for mesh than for suture repair (45 versus 38 min). Rates of early complications such as seroma, haematoma or wound infection were similar in the two groups. The hernia recurrence rate was higher after suture repair (11 per cent) than after mesh repair (1 per cent) (P = 0.0015). CONCLUSION: Prosthetic repair could become the standard treatment for primary umbilical hernia in adults. 相似文献
16.
Introduction Recurrence rates for open repair of ventral/incisonal hernias historically range from 6% for the classic Rives-Stoppa repair
to 35–45% for some of the techniques more commonly used in the United States. We report a modification to the classic Rives-Stoppa
repair that allows intraperitoneal placement of the prosthetic, secured with a running suture. The abdominal muscles are closed
over the mesh to protect it from any superficial wound problems that might develop and to restore normal architecture of the
abdominal wall.
Method A chart review was undertaken on all patients undergoing open ventral incisional hernia repair by a single surgeon from 2000
to 2006. All hernias were repaired with the intraperitoneal modification mimicking the principles of the Rives-Stoppa repair.
Patient characteristics and operative and postoperative data were collected. Primary outcome was recurrence of hernia. Secondary
outcomes were complications and rate of mesh infection.
Results One hundred and fifteen patients were evaluated. Thirty-four patients had repair of recurrent ventral hernias. The average
patient was obese, female, and 59 years old. Twenty-five patients used tobacco, eleven were diabetic, and seven used chronic
corticosteroids. Meshes utilized included ePTFE, coated polyester, coated polypropylene, and biologic mesh. Average size of
mesh was 465.4 cm2. There were four recurrences (3.4%), three of which were due to mesh infection requiring mesh removal. Recurrence rate not
secondary to mesh removal was 0.9%. Complications occurred in 26% with seroma formation being the most frequent (16%).
Conclusion The intraperitoneal modification to the original Rives-Stoppa repair leads to a very low recurrence rate for large ventral
hernia repairs with minimal complications and low rate of mesh infection.
Presented at the 2007 American Hernia Society Meeting, Hollywood, FL, USA. 相似文献
17.
Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia 总被引:40,自引:0,他引:40 下载免费PDF全文
Burger JW Luijendijk RW Hop WC Halm JA Verdaasdonk EG Jeekel J 《Annals of surgery》2004,240(4):578-585
OBJECTIVE: The objective of this study was to determine the best treatment of incisional hernia, taking into account recurrence, complications, discomfort, cosmetic result, and patient satisfaction. BACKGROUND: Long-term results of incisional hernia repair are lacking. Retrospective studies and the midterm results of this study indicate that mesh repair is superior to suture repair. However, many surgeons are still performing suture repair. METHODS: Between 1992 and 1998, a multicenter trial was performed, in which 181 eligible patients with a primary or first-time recurrent midline incisional hernia were randomly assigned to suture or mesh repair. In 2003, follow-up was updated. RESULTS: Median follow-up was 75 months for suture repair and 81 months for mesh repair patients. The 10-year cumulative rate of recurrence was 63% for suture repair and 32% for mesh repair (P < 0.001). Abdominal aneurysm (P = 0.01) and wound infection (P = 0.02) were identified as independent risk factors for recurrence. In patients with small incisional hernias, the recurrence rates were 67% after suture repair and 17% after mesh repair (P = 0.003). One hundred twenty-six patients completed long-term follow-up (median follow-up 98 months). In the mesh repair group, 17% suffered a complication, compared with 8% in the suture repair group (P = 0.17). Abdominal pain was more frequent in suture repair patients (P = 0.01), but there was no difference in scar pain, cosmetic result, and patient satisfaction. CONCLUSIONS: Mesh repair results in a lower recurrence rate and less abdominal pain and does not result in more complications than suture repair. Suture repair of incisional hernia should be abandoned. 相似文献
18.
Randomized clinical trial of suture repair, polypropylene mesh or autodermal hernioplasty for incisional hernia 总被引:24,自引:0,他引:24
Korenkov M Sauerland S Arndt M Bograd L Neugebauer EA Troidl H 《The British journal of surgery》2002,89(1):50-56
BACKGROUND: Since conventional suture repair for incisional hernia is associated with high recurrence rates, alloplastic and autoplastic prosthetic techniques have been suggested. METHODS: In a randomized trial, 160 patients with simple or complex hernias underwent either suture repair, autodermal skin graft or onlay polypropylene mesh repair. Suture repair was not done in complex hernias. This report concerns a planned interim analysis. RESULTS: At mean follow-up of 16 months, there were 17 hernia recurrences that were distributed similarly between the surgical techniques. There were fewer infectious complications after suture repair (three of 33 patients) than after skin graft or mesh repair (seven of 39 and five of 28 for simple hernias; seven of 31 and ten of 29 respectively for complex hernias) (P not significant). The severity of infections after polypropylene mesh implantation prompted the trial committee to discontinue the study. No differences were noted in duration of stay in hospital and quality of life. However, pain was significantly more frequent after polypropylene mesh repair (pooled risk ratio 2.9 and 1.8 at 6 weeks and 1 year respectively). CONCLUSION: Suture repair was safe for small incisional hernias. Both autoplastic and alloplastic hernia repair yielded comparably low recurrence rates, but led to a high rate of wound infection. 相似文献
19.
Rodrigo Gonzalez Edward Mason Titus Duncan Russell Wilson Bruce J Ramshaw 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2003,7(4):323-328
BACKGROUND: The use of prosthetic material for open umbilical hernia repair has been reported to reduce recurrence rates. The aim of this study was to compare outcomes after laparoscopic versus open umbilical hernia repair. METHODS: We reviewed all umbilical hernia repairs performed from November 1995 to October 2000. Demographic data, hernia characteristics, and outcomes were compared. RESULTS: Of the 76 patients identified, 32 underwent laparoscopic repair (LR), 24 primary suture repairs (PSR), and 20 open repairs with mesh (ORWM). Preoperative characteristics were similar between groups. Hernia size was similar between LR and ORWM groups, and both were larger than that in the PSR group. ORWM compared with the other techniques resulted in longer operating time, more frequent use of drains, higher complication rates, and prolonged return to normal activities (RTNA). The length of stay (LOS) was longer in the ORWM than in the PSR group. When compared with ORWM, LR resulted in lower recurrence rates. LR resulted in fewer recurrences in patients with previous repairs and hernias larger than 3 cm than in both open techniques. CONCLUSIONS: LR results in faster RTNA, and lower complication and recurrence rates compared with those in ORWM. Patients with larger hernias and previous repairs benefit from LR. 相似文献
20.
Is prosthetic umbilical hernia repair bound to replace primary herniorrhaphy in the adult patient? 总被引:11,自引:0,他引:11
A. Arroyo Sebastián F. Pérez P. Serrano D. Costa I. Oliver R. Ferrer J. Lacueva R. Calpena 《Hernia》2002,6(4):175-177
Abstract. Given the outstanding outcome that prosthetic repair has recently achieved in the repair of inguinal hernia, we wonder whether
it should be implemented as the gold-standard technique for umbilical hernia repair. We report on 213 adult patients who underwent
surgery for umbilical hernia at our Day Surgery Unit from June 1992 to January 1998. Criteria for exclusion included problematic
social and family environment and ASA IV status. A polypropylene plug was placed in small umbilical defects, whereas large
defects (>3 cm in diameter) were repaired with a polypropylene mesh. The mean follow-up was 64 months. The mean age was 57.1 years,
with females accounting for the majority (57.8%). Most patients (88.3%) were classified as ASA I-II. With regard to the hernia
size, 143 patients (67.1%) presented with small defects (<3 cm). The anaesthetic technique of choice was local plus sedation.
Reported complications included seroma (5.6%), haematoma (2.3%), wound infection (1.4%), and intolerance to prosthesis (0.95%),
the last causing recurrence. The overall recurrence rate at a mean follow-up of 64 months was 0.95%. Prosthetic umbilical
hernia repair can safely be performed in adults, and the rate of recurrence in this study is low in comparison to primary
tissue repair.
Electronic Publication 相似文献