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1.
Trocar site hernia after laparoscopic ventral hernia repair 总被引:3,自引:2,他引:1
Boldó E Perez de Lucia G Aracil JP Martin F Escrig J Martinez D Miralles JM Armelles A 《Surgical endoscopy》2007,21(5):798-800
Background The incidence of trocar site hernia (TSH) after laparoscopic ventral hernia repair (LVHR) is reported to be low. The present
study investigates the associated risk factors, with a view to preventing this complication.
Methods A retrospective study was made of the incidence of TSH in a personal series of LVHR, recording anthropometric and clinical
data on the patients. Risk factors were assessed by bivariate and multivariate analyses. The patients were subjected to clinical
and telephone follow-up.
Results In a series of 27 LVHR, the incidence of TSH was 22% (6 patients). The use of meshes larger than 10 × 15 cm for LVHR was the
only TSH risk factor to reach statistical significance. Female gender and diabetes showed a higher incidence in the TSH group.
Conclusions The use of large meshes may be a risk factor for TSH. We believe this to be due to dilatation of the trocar orifice during
introduction of the mesh, and also to postoperative retraction of the mesh.
This work was presented at the 16th World Congress of the International Association of Surgeons and Gastroenterologists, Madrid,
May 2006. 相似文献
2.
Background
Laparoscopic ventral hernia repair (LVHR) has gained worldwide acceptance, due to its minimally invasive character, feasibility and low rate of complications. Animal experiments have shown marked adhesions to the intraperitoneal mesh (IPM), the clinical consequences being unclear. This study aimed to describe the extension of adhesions to the mesh, 5–7 years after LVHR, using two validated non-invasive radiologic methods. 相似文献3.
Prof. Dr. C. Langer H. Forster F. Konietschke B.-W. Raab A. Schaper E. Brunner H. Becker 《Der Chirurg》2010,81(8):735-745
Objectives
According to an estimated mesh shrinkage following hernia repair of up to 40% a current dogma in hernia surgery requires a mesh overlap of 5 cm around the hernia. However, no valid data addressing this problem of mesh shrinkage are available at present.Patients and methods
Within the framework of a prospective randomized double-blinded clinical trial, 50 patients were operated on for a ventral abdominal hernia with the open sublay technique using specially prepared radio-opaque polypropylene (PP) meshes. Of the patients 27 received a conventional heavyweight mesh (P group) and 23 a new lightweight mesh construction (NK group). Follow-up for at least 2 years after mesh repair included conventional abdominal x-rays after 7 days, 3 weeks and 4, 12 and 24 months, as well as computed tomography after 7 days and 4 and 12 months. Main criteria were mesh shrinkage, recurrence and complication rates and quality of life comparing groups P and NK.Results
In 46 cases (92%) no mesh shrinkage could be detected and only 4 meshes (8%) showed a moderate shrinkage (1 of 22.2%, 2 of 8% and 1 of 3%) all from the P group. While no hernia recurrences were found, 2 surgical complications occurred with 1 seroma in the P group and 1 hematoma in the NK group. Quality of life showed a linear improvement over time up to the 2 year time point following mesh repair with advantages for the NK group. Pain and mobility scores reached standard values 12 months postoperatively without significant differences between the two groups.Conclusions
In principle PP meshes following an uncomplicated ventral hernia repair do not shrink at all. A moderate shrinkage in isolated cases might occur following heavyweight mesh implantation. Under controlled conditions recurrence as well as complication rates are equal for heavyweight and lightweight PP meshes. Quality of life improves up to 2 years following mesh repair with a trend to a better outcome for lightweight meshes. Pain and mobility scores reached standard values 12 months postoperatively without significant differences between the lightweight and heavyweight meshes. 相似文献4.
Introduction Parastomal hernia is a well known clinical problem, and up to 50% of all patients having a stoma will eventually develop a
parastomal hernia. There are many surgical options available for the repair of a parastomal hernia, but the prevention of
hernia development has only recently received scientific attention. The most encouraging results have included the use of
a mesh inserted at the primary operation. We have, therefore, chosen to review the literature regarding the results of operative
techniques, including mesh placement, for the prevention of a parastomal hernia.
Materials We performed a systematic literature search and found five publications which, in total, included 112 patients having a prophylactic
mesh during their stoma formation. One study was a randomized controlled trial which included 54 patients, of which, 21 patients
had a prophylactic mesh. The remaining four studies were prospective observational series.
Results Three of the 112 patients had a hernia recurrence within the follow-up period, which ranged from 2 to 48 months. One of the
52 patients that had a sublay mesh placed at the primary operation and two of 60 patients that had an onlay mesh developed
a hernia. There were no infections or other serious complications related to the mesh in any of the studies.
Conclusion The results of placing a prophylactic mesh when performing a permanent stoma in the elective situation are very promising.
However, the data are preliminary and with relatively short follow-up times. Therefore, it should be confirmed in larger,
double-blinded, controlled randomized clinical trials whether there are short- and long-term advantages of placing a mesh
at the primary operation, and where the mesh should be placed in the abdominal wall. 相似文献
5.
Ernst J. P. Schoenmaeckers Steef B. A. van der Valk Huib W. van den Hout Johan F. T. J. Raymakers Srdjan Rakic 《Surgical endoscopy》2009,23(7):1620-1623
Background The potential for shrinkage of intraperitoneally implanted meshes for laparoscopic repair of ventral and incisional hernia
(LRVIH) remains a concern. Numerous experimental studies on this issue reported very inconsistent results. Expanded polytetrafluoroethylene
(ePTFE) mesh has the unique property of being revealed by computed tomography (CT). We therefore conducted an analysis of
CT findings in patients who had previously undergone LRVIH with an ePTFE mesh (DualMesh, WL Gore, Flagstaff, AZ, USA) in order
to evaluate the shrinkage of implanted meshes.
Patients and methods Of 656 LRVIH patients with DualMesh, all patients who subsequently underwent CT scanning were identified and only those with
precisely known transverse diameter of implanted mesh and with CT scans made more than 3 months postoperatively were selected
(n = 40). Two radiologists who were blinded to the size of the implanted mesh measured in consensus the maximal transverse diameter
of the meshes by using the AquariusNET program (TeraRecon Inc., San Mateo, CA, USA). Mesh shrinkage was defined as the relative
loss of transverse diameter as compared with the original transverse diameter of the mesh.
Results The mean time from LRVIH to CT scan was 17.9 months (range 3–59 months). The mean shrinkage of the mesh was 7.5% (range 0–23.7%).
For 11 patients (28%) there was no shrinkage at all. Shrinkage of 1–10% was found in 16 patients (40%), of 10–20% in 10 patients
(25%), and of 20–24% in 3 patients (7.5%). No correlation was found regarding the elapsed time between LRVIH and CT, and shrinkage.
There were two recurrences, one possibly related to shrinkage.
Conclusion Our observations indicate that shrinkage of DualMesh is remarkably lower than has been reported in experimental studies (8–51%).
This study is the first to address the problem of shrinkage after intraperitoneal implantation of synthetic mesh in a clinical
material. 相似文献
6.
Background Incisional hernias after laparotomy are a large financial burden for society as well as for the patients suffering from pain
and limitations of activity over time. The introduction of alloplastic materials such as polypropylene seems to improve the
results. The question of whether to apply open or laparoscopic implantation of the mesh is of ongoing interest. We compare
the available alloplastic materials and try to clarify the question of whether the laparoscopic procedure is superior to the
conventional (open) technique based on the available randomized studies.
Methods All available meshes for intraperitoneal and extraperitoneal implantation were described regarding their handling and their
pros and cons. A database search (PubMed, Medline, Ovid, and in the secondary literature) was carried out to retrieve all
randomized studies comparing laparoscopic and open hernia repair. Data were reviewed by two independent scientists for surgical
and statistical design.
Results The ideal mesh for a laparoscopic maintenance of abdominal wall hernias as well as the optimal fixation of the mesh has not
been found yet. Recent available literature shows no evidence demonstrating the superiority of one of these meshes. The available
studies found a lower infection rate, but higher occurrence of seroma for the laparoscopic procedure. The value of the different
studies is reduced due to deficiency in study design and power. Guidelines for further studies are discussed to avoid surgical
and statistical pitfalls.
Conclusions Laparoscopic incisional hernia repair shows, in some (randomized) studies as well as a large number of retrospective analyses
and in case control studies, superiority compared to conventional hernia repair. Long-term results with a high level of evidence
are not available. Additional well-designed randomized trials including long-term observation of patients are required in
order to clarify a number of interesting questions. 相似文献
7.
Background Generous overlap by a well-transfixed mesh is important in laparoscopic ventral hernia repair (LVHR). Mesh is usually introduced
through a 10-mm trocar and fixed by tackers or transfixed by sutures. Ten-millimeter trocar sites are more prone to hernia
development. Transfixation done using a suture passer inflicts some trauma and the site may become painful. This study reports
a mesh insertion technique avoiding a 10-mm myofascial port, double-breasted fascial closure of the hernial defect, and transfixation
in a relatively atraumatic manner.
Methods This prospective study was conducted by enrolling the patients attending our surgery clinic. They were candidates for LVHR.
Informed consent was obtained from each patient before the procedure. The study was approved by the Ethical Review Board of
the Hospital and conducted as per good clinical practice (GCP) guidelines.
Results Between April 2004 and June 2006, 29 ventral hernia patients were enrolled without any exclusion. All patients had LVHR performed
with this technique. Mean operative time and hospital stay were 65 min and <1 day, respectively. There were no perioperative
complications, conversion, infection, trocar site or recurrent herniation or mortality. The majority of the patients were
operated on as day-care surgery. Patients were followed up telephonically for the first 48 h and then by visiting us regularly.
There was no postoperative visible bulge.
Conclusion Mesh insertion by avoiding 10-mm trocar, double-breasted defect closure, and transfixation using atraumatic needles is a technically
easy, safe, and patient-friendly procedure. 相似文献
8.
Incisional hernias and other ventral hernias are common surgical problems. It is estimated that incisional hernia complicates about 2 % to 10 % of laparotomies. Ventral and incisional hernia repairs are among the common surgeries done by a general surgeon. It is proven beyond any doubt that suture repair of these hernias should not be done as recurrence rates are unacceptably high, some series reporting as high as 54 % on long-term follow-up. A prosthetic mesh should always be used in ventral hernia repair (VHR). Now, the polypropylene mesh (PPM) has become the prosthetic mesh of choice in the repair of hernias, including inguinal hernia. However, with the advent of laparoscopic repair where the mesh is placed intraperitoneally, concerns regarding safety of PPM are raised. Newer meshes are introduced, claiming lesser complication rate. Many types of newer meshes are available now. Newer meshes are invariably costlier than PPM by 15–20 times. Is this extra cost worth? We looked in to available literature for an answer. 相似文献
9.
Purpose
Current hernia literature shows that the use of mesh in ventral hernia repair reduces the risk of recurrence significantly. In laparoscopic repair, the mesh is placed intraperitoneally. Accordingly, the close contact between mesh and viscera involves a risk of adhesion formation. In this experimental study, we examined the degree of de novo adhesion formation over time to currently available meshes. 相似文献10.
Junge K Binnebösel M Rosch R Jansen M Kämmer D Otto J Schumpelick V Klinge U 《Surgical endoscopy》2009,23(2):327-333
Background Effective laparoscopic ventral herniorrhaphy mandates the use of an intraperitoneal mesh. Visceral adhesions and shrinkage
of prosthetics may complicate repairs. The aim of this study was to compare adhesion formation, mesh shrinkage and tissue
ingrowth after intra-abdominal placement of a novel two-component monofilament mesh structure made of polypropylene (PP) and
polyvinylidenfluoride (PVDF) with current alternatives.
Materials and methods Forty Sprague-Dawley rats were used in this study. Mesh samples were fixed as intra-abdominal only mesh at the right lateral
abdominal wall. The study groups were: PVDF+PP (polypropylene parietally and polyvinylidenfluoride viscerally), PP+Col (polypropylene
with a collagenoxidized film), ePTFE (smooth surface viscerally and a textured surface parietally), and PP (a pure polypropylene
mesh serving as control). The meshes were explanted after 30 days. Adhesions were scored as a percentage of explanted biomaterials’
affected surface area; prosthetic shrinkage was calculated. Foreign-body reaction to mesh materials was measured by investigating
the amount of inflammatory infiltrate and fibrotic tissue formation.
Results In terms of adhesion score, the pure PP mesh showed the highest values followed by the ePTFE, PVDF+PP, and PP+Col meshes.
Quantitative assessment of adhesion area revealed a significantly higher value of the pure PP mesh sample (62.0 ± 22.1%) compared
with the PP+Col (26.8 ± 12.1%) and the PVDF+PP mesh (34.6 ± 8.2%). Percentage of shrinkage showed a significantly higher value
of the ePTFE mesh (52.4 ± 13.9%) compared with all other mesh modifications (PP+Col 19.8 ± 13.9%, PVDF+PP 19.9 ± 7.0%, and
PP 26.8 ± 9.5%). Inflammatory infiltrate was significantly reduced in the PVDF+PP mesh group compared with all other mesh
samples.
Conclusion The use of the novel two-component monofilament mesh structure made of polypropylene and polyvinylidenfluoride was found to
be favorable regarding adhesion formation and mesh shrinkage compared to conventional mesh materials used for intra-abdominal
placement. 相似文献
11.
Introduction
Laparoscopic approach has become standard for many ventral hernia repairs. The benefits of minimal access include reduced wound complications, faster functional recovery, and improved cosmesis, among others. However, “bridging” of hernia defects during traditional laparoscopic ventral hernia repair (LVHR) often leads to seromas or bulging and, importantly, does not restore a functional abdominal wall. We have modified our approach to LVHR to routinely utilize transabdominal defect closure (“shoelacing” technique) prior to mesh placement. Herein, we aim to analyze outcomes of LVHR with shoelacing. 相似文献12.
Introduction
The purpose of this study was to evaluate the acute fixation strength of fibrin sealant as an alternative fixation method for laparoscopic ventral hernia repair (LVHR) when utilized with absorbable and nonabsorbable barrier meshes. 相似文献13.
Weyhe D Belyaev O Müller C Meurer K Bauer KH Papapostolou G Uhl W 《World journal of surgery》2007,31(1):234-244
Background Despite convincing advantages offered by meshes, their use in hernia surgery remains controversial because of fears concerning
the long-term effects of their implantation. To improve biocompatibility, a large variety of newly developed light meshes
has been introduced to the market.
This overview of the literature aimed to establish whether absolute material reduction (g per implanted mesh), use of absorbable
components, and coating by inert materials are evidence-based ways to improve biocompatibility of meshes.
Method A review of the current English and German language literature on the outcome of groin und incisional hernia mesh repair was
performed. Both basic research and clinical trials were used as sources of data. Meta-analyses and randomized controlled trials
were given priority and were referred to whenever possible.
Results Operative technique was an independent prognostic factor for the clinical outcome. Mesh construction and composition as characterized
by pore size and filament structure appeared to be more important determinants of foreign body reaction after implantation
than absolute material reduction of 1 g or more per implant. No data exist about an oncogenic effect of alloplastic materials
in humans, but disturbed fertility in animal studies remains an issue of concern and should be further investigated.
Conclusions According to data from current randomized controlled trials and retrospective studies, light meshes seem to have some advantages
with respect to postoperative pain and foreign body sensation. However, their use is associated with increased recurrence
rates. Light meshes offer no advantages with respect to alleviating severe chronic groin pain. At the same time, experimental
data reveal that material composition and mesh structure may significantly affect foreign body reaction. 相似文献
14.
Evangelos P Misiakos Anastasios Machairas Paul Patapis Theodore Liakakos 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2008,12(2):117-125
BACKGROUND: The purpose of this study was to analyse the surgical techniques, perioperative complications, and recurrence rate of laparoscopic ventral hernia repair (LVHR), in comparison with the open ventral hernia repair (OVHR), based on the international literature. METHODS: A Medline search of the English literature was performed using the term "laparoscopic ventral hernia repair." Further articles were found by cross-referencing the references of each main article. RESULTS: Current literature on the topic suggests that LVHR is a safe alternative to the open method with the main advantages being minimal postoperative pain, a shorter convalescence period, and better cosmetic results. Main complications after the laparoscopic approach, such as incidental enterotomy, protracted pain, postoperative seroma, or mesh infection occur at an acceptable rate. Furthermore, most articles favor LVHR versus OVHR in terms of recurrence rate. CONCLUSIONS: Although further randomized studies are needed to draw safe conclusions in terms of complications and recurrence, LVHR is fast becoming the standard approach in the repair of abdominal wall hernias. 相似文献
15.
Background Success of totally extraperitoneal (TEP) inguinal herniorrhaphy depends upon strengthening of the weakened native tissue by
inflammation resulting in mesh–aponeurosis scar tissue (MAST) complex formation. The inflammatory response attributable to
polypropylene (PP) content of the mesh is linked to weight of PP and pore size of the mesh. Continuation of the inflammatory
process beyond MAST complex formation can entrap contiguous structures, leading to adverse outcome such as groin pain. Reduction
of PP content has been shown to be beneficial in animal studies. Paucity of randomized controlled trials (RCTs) on human beings
has left choice of mesh to surgeon preference or cost. We carried out a double-blind RCT comparing heavy- and lightweight
PP-based meshes in TEP.
Patients and methods Consecutive, married, sexually active male candidates for bilateral TEP herniorrhaphy were enrolled without any exclusion,
with ethical and informed consent protocol. Standard TEP technique was followed for day-care surgery. Heavy- and lightweight
meshes were implanted in each patient, one in either groin after randomization. Surgeon and patient were blinded to side of
groin and type of mesh. An independent doctor (AID) evaluated the patients for groin pain, discomfort, sexual dysfunction,
and clinical recurrence. A nonmedical secretary/AID transferred prospective data for both sides of groin collected by AID
to Microsoft Excel.
Results Twenty-five bilateral TEPs implanting 25 heavy- and 25 lightweight PP meshes, one of each type in each patient, were performed
from December 2005 to July 2007 without difficulty or complication. Lightweight PP mesh was associated with significantly
better pain scores, patient comfort, and sexual function. There was no infection or recurrence with either type of mesh.
Conclusion Lightweight PP mesh is associated with significantly better outcomes in TEP inguinal herniorrhaphy as compared with heavyweight
PP mesh.
This work was presented at the SAGES 2008 meeting as an oral paper (abstract ID 19,025) and at the 11th World Congress of
Surgery held at Yokohama, Japan as an oral paper (abstract ID WWS13-2). 相似文献
16.
Novitsky YW Cobb WS Kercher KW Matthews BD Sing RF Heniford BT 《Archives of surgery (Chicago, Ill. : 1960)》2006,141(1):57-61
HYPOTHESIS: Ventral abdominal hernias represent a frequent and often formidable clinical problem, especially in obese patients. Because laparoscopic ventral hernia repair (LVHR) results in few complications and a low recurrence rate, the use of minimally invasive techniques in this subgroup of patients may minimize perioperative complications and failure rates. DESIGN: Retrospective review of prospectively collected data. SETTING: Tertiary care hospital. PATIENTS: One hundred sixty-three obese patients (body mass index [calculated as weight in kilograms divided by the square of height in meters], > or =30) who underwent LVHR at our institution between July 1, 1998, and December 31, 2003. INTERVENTION: Laparoscopic ventral hernia repair with an expanded polytetrafluoroethylene mesh. MAIN OUTCOME MEASURES: Patient age, sex, body mass index, size of fascial defect and mesh, operating time, operative blood loss, length of hospitalization, complications, and hernia recurrences. RESULTS: Ninety-eight women and 65 men, with a mean body mass index of 38, underwent LVHR. Twenty patients (12.3%) had 21 postoperative complications. There was no perioperative mortality. The mean length of hospital stay was 2.6 days. The recurrence rate was 5.5% at a mean follow-up of 25 months (range, 1-73 months). CONCLUSIONS: A low rate of conversion to laparotomy, minimal perioperative morbidity, and the absence of perioperative mortality in this series indicate the safety of LVHR in obese patients with complex hernias. In addition, a success rate of more than 94.5% suggests improved efficacy of LVHR compared with the historical rates among control subjects undergoing open surgery. In experienced hands, LVHR may be the approach of choice for most patients with a body mass index of 30 or more. 相似文献
17.
Laparoscopic repair of incisional hernia in solid organ‐transplanted patients: the method of choice?
Jan R. Lambrecht Morten Skauby Erik Trondsen Arild Vaktskjold Ole M. Øyen 《Transplant international》2014,27(7):712-720
Due to immunosuppressive (IS) therapy, incisional hernias are overrepresented in the organ‐transplanted (Tx) population with larger defects, a high rate of recurrence, and a tendency toward more seromas and infectious problems. Thirty‐one Tx/IS patients with a control group of 70 non‐IS patients with incisional hernia (6/7 recurrences) were included in a prospective interventional study. Both cohorts were treated with laparoscopic ventral hernia repair (LVHR). Follow‐up time and rate was 37 months and 95%. One hundred LVHR's were completed as there was one conversion in the Tx/IS group. No late infections or mesh removals occurred. Recurrence rates were 9.7% vs. 4.2% (P = 0.37) and the overall complication rates were 19% vs. 27% (P = 0.80). The Tx/IS group had a higher mesh‐protrusion rate (29% vs. 13%, P = 0.09), but also larger hernias. Polycystic kidney disease was overrepresented in the Tx cohort (44% of kidney‐Tx). Incisional hernias in Tx/IS patients may be treated by LVHR with the same low complication rate and recurrence rate as non‐IS patients. By LVHR, the highly problematic seroma/infection problems encountered in Tx/IS patients treated by conventional open technique seem almost eliminated. The minimally invasive procedure seems particularly rational in the Tx/Is population and should be the method of choice. (ClinicalTrials.gov number: NCT00455299, date: 5 May 2006). 相似文献
18.
19.
Duyen H. Nguyen Mylan T. Nguyen Erik P. Askenasy Lillian S. Kao Mike K. Liang 《World journal of surgery》2014,38(12):3097-3104
Laparoscopic ventral hernia repair (LVHR) has grown in popularity. Typically, this procedure is performed with a mesh bridge technique that results in high rates of seroma, eventration (bulging), and patient dissatisfaction. In an effort to avoid these complications, there is growing interest in the role of laparoscopic primary fascial closure with intraperitoneal mesh placement. This systematic review evaluated the outcomes of closure of the central defect during LVHR. A literature search of PubMed, Cochrane databases, and Embase was conducted using PRISMA guidelines. MINORS was used to assess the methodologic quality. Primary outcome was hernia recurrence. Secondary outcomes were surgical-site infection, seroma formation, bulging, and patient-centered items (satisfaction, chronic pain, functional status). Eleven studies were identified, eight of which were case series (level 4 data). Three comparative studies examined the difference between closure and nonclosure of the fascial defect during laparoscopic ventral incisional hernia repairs (level 3 and 4 data). These studies suggested that primary fascial closure (n = 138) compared to nonclosure (n = 255) resulted in lower recurrence rates (0–5.7 vs. 4.8–16.7 %) and seroma formation rates (5.6–11.4 vs. 4.3–27.8 %). Follow-up periods for both groups were similar (1–108 months). Only one study evaluated patient function and clinical bulging. It showed better outcomes with primary fascial closure. Closure of the central defect during LVHR resulted in less recurrence, bulging, and seroma than nonclosure. Patients with closure were more satisfied with the results and had better functional status. The quality of the data was poor, however. A randomized controlled trial to evaluate the role of closure of the central defect during LVHR is warranted. 相似文献
20.
Laparoscopic ventral hernia repair: is there an optimal mesh fixation technique? A systematic review
Emmelie Reynvoet Ellen Deschepper Xavier Rogiers Roberto Troisi Frederik Berrevoet 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2014,399(1):55-63