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1.
Background: This report describes the technique and early results of a simple outpatient laparoscopic ventral hernia repair.
Methods: Data were gathered prospectively for all laparoscopic ventral hernia repairs from January 1996 to December 1997 at a 228-bed
hospital. Prolene mesh was stapled to the peritoneal surface of the abdominal wall, leaving sac in situ and mesh uncovered. Patients were seen by the operating surgeon within 2 months, and by an impartial surgeon (J.S.) after
3 to 14 months (average, 7 months; median, 6 months).
Results: Repairs involved 44 hernias with orifice sizes 2 to 20 cm in diameter, and an average area of 20 cm2. Of these 44 hernias, 36 were postoperative and 8 primary. Furthermore, 20% were recurrent hernias. There were four conversions.
The outpatient rate was 98%, with one readmission for ileus. The early recurrence rate was 5%.
Conclusions: Laparoscopic mesh onlay repair is a safe, easy, and effective procedure with minimal discomfort and a low early recurrence
rate that can be performed safely on an outpatient basis.
Received: 15 October 1998/Accepted: 18 October 1999/Online publication: 10 April 2000 相似文献
2.
Background: The role of laparoscopic inguinal hernia repair is controversial. The aim of this study was to find out whether it is justified
to switch from the predominantly modified Bassini repair which the authors had been using to laparoscopic repair.
Methods: Randomized controlled trial in 120 eligible patients admitted for elective hernia repair in a university hospital.
Results: Sixty patients underwent laparoscopic transabdominal preperitoneal mesh repair; the other 60 patients had an open repair,
mostly with the modified Bassini technique. Operative time for laparoscopic repair was significantly longer, mean (s.d.) 95
(28) min vs 67 (27) min (p < 0.001). The mean analogue pain score during the first 24 h after surgery was 36.2 (20.2) in the laparoscopic group and
49.3 (24.9) in the open group (p= 0.006). The requirement for narcotic injections and postoperative disability in walking 10 m and getting out of bed were
also significantly less following laparoscopic repair. The postoperative hospital stay was not significantly different, mean
2.6 (1.2) days for laparoscopic repair and 3.0 (1.5) days for open repair (p= 0.1). Patients were able to perform light activities without pain or discomfort sooner after laparoscopic repair, median
interquartile range 8 (5–14) days vs 14 (8–19) days (p= 0.013). Patients also resumed heavy activities sooner, but not significantly, after laparoscopic repair, median 28 (17–60)
days vs 35 (20–56) days (p= 0.25). The return to work was not significantly different, median 14 (8–25) days after laparoscopic repair and 15 (11–21)
days after open repair (p= 0.14). After a mean follow-up of 32 months one patient developed a recurrent hernia 3 months after a laparoscopic repair.
Laparoscopic repair was more costly than open repair by approximately $400.
Conclusions. Laparoscopic inguinal hernia repair was associated with less early postoperative pain and disability and earlier return to
full activities than open repair, but there were no benefits regarding postoperative hospital stay and return to work; laparoscopic
repair was also more costly.
Received: 23 May 1997/Accepted: 1 August 1997 相似文献
3.
Background: The laparoscopic repair of inguinal hernia is still controversial. Transabdominal preperitoneal repair violates the peritoneal
cavity and may result in visceral injuries or intestinal obstruction. The laparoscopic extraperitoneal approach has the disadvantage
of being technically demanding and requires extensive extraperitoneal mobilization. The Lichtenstein repair gives good long-term
results, is easy to learn, can be performed under local anesthesia, but requires a larger incision.
Methods: We describe a novel percutaneous tension-free prosthetic mesh repair performed through a 2-cm groin incision. The inguinal
canal is traversed with the aid of a 5-mm video-endoscope and the canal is widened using specially designed balloons. Spermatic
cord mobilization, identification and excision of the indirect sac, and posterior wall repair are carried out under endoscopic
guidance.
Results: Between October 1993 and July 1995, 85 primary inguinal hernia repairs (48 indirect and 33 direct) were performed on 81 patients
(80 men, one woman) by the author (A.D.). The mean age was 41 years (range 17–83 years). Six repairs were performed under
local anesthetic. Mean operative time was 42 min (range 25–74). Mean hospital stay was 1.2 days (0–3 days). The mean return
to normal activity was 8 days (2–10 days). Eight complications have occurred: a serous wound discharge, two scrotal hematomas,
a scrotal swelling that resolved spontaneously, wound pain lasting 2 weeks, an episode of urinary retention, and two recurrences
early in the series (follow-up 1–22 months).
Conclusion: The endoscopically guided percutaneous hernia repair avoids the disadvantages of laparoscopy (i.e., lack of stereoscopic
vision, reduced tactile feedback, unfamiliar anatomical approach, risk of visceral injury), yet the use of endoscopic instrumentation
allows operation through a 2-cm incision. The minihernia repair thus combines the virtues of an open tension-free repair with
minimal access trauma.
Received: 21 May 1996/Accepted: 8 August 1996 相似文献
4.
Comparison of laparoscopic and open repair of incisional and primary ventral hernia: results of a prospective randomized study 总被引:4,自引:0,他引:4
Background Incisional hernia is an important complication of abdominal surgery. Its repair has progressed from a primary suture repair
to various mesh repairs and laparoscopic repair. Laparoscopic mesh repair is a promising alternative, and in the absence of
consensus, needs prospective randomized controlled trials.
Methods Between April 2003 and April 2005, 66 patients with incisional, primary ventral and recurrent hernias were randomized to receive
either open retrorectus mesh repair or laparoscopic mesh repair. These patients were followed up at 1-, 3-, and 6-month intervals
thereafter for a mean of 12.17 months (open repair group) and 13.73 months (laparoscopic repair group).
Results Lower abdominal hernias after gynecologic operations constituted the majority of the hernias (∼50%) in both groups. There
was no significant injury to viscera or vessel in either group and no conversions. The defect size was 42.12 cm2 in the open (group 1) and 65.66 cm2 in the laparoscopic group (group 2), and the prosthesis sizes were, respectively, 152.67 cm2 and 203.83 cm2. The hospital stay was 3.43 days in open group and 1.47 days in laparoscopic group (p = 0.007). There was no significant difference in the pain scores between the two groups. More wound-related infectious complications
occurred in the open group (33%) than in the laparoscopic group (6%) (p = 0.013). There was one recurrence in the open repair group (3%) and two recurrences in laparoscopic group (6%) (p = 0.55).
Conclusions Laparoscopic repair of incisional and ventral hernias is superior to open mesh repair in terms of significantly less blood
loss, fewer complications, shorter hospital stay, and excellent cosmetic outcome. 相似文献
5.
C. Palanivelu K. V. Jani P. Senthilnathan R. Parthasarathi M. V. Madhankumar V. K. Malladi 《Hernia》2007,11(3):223-228
Background This study reports medium-term outcomes of laparoscopic incisional hernia repair.
Study Design Laparoscopic repair was performed on 721 patients with ventral hernia. After adhesiolysis the defect was closed with no. 1
polyamide suture or loop. This was followed by reinforcement with intraperitoneal onlay repair with a bilayered mesh.
Results Laproscopic repair of ventral hernia was performed on 613 females and 108 males. Of these, 185 (25.7%) were recurrent incisional
hernias of which 93 had undergone previous open hernioplasty. The remaining 92 patients had previously undergone sutured repair.
The average operating time was 95 min (range 60–115 min). Conversion rate was 1%. The average hospital stay was 2 days (range
1–6 days). The commonest complication was seroma formation at the incisional hernia site. Full-thickness bowel injury occurred
in two patients. The mean follow-up period was 4.2 years (range 3 months to 10 years). Recurrence was noted in four (0.55%)
patients.
Conclusion Laparoscopic repair is well-tolerated and can be accomplished with minimum morbidity in ventral hernias. 相似文献
6.
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
7.
F. K. Toy R. W. Bailey S. Carey C. W. Chappuis M. Gagner L. G. Josephs E. C. Mangiante A. E. Park A. Pomp R. T. Smoot Jr. J. F. Uddo Jr. G. R. Voeller 《Surgical endoscopy》1998,12(7):955-959
Background: A standard technique for laparoscopic ventral hernioplasty (peritoneal onlay using an expanded polytetrafluoroethylene [ePTFE]
patch for hernias ≥4 cm2) is being used in a prospective, multicenter, long-term study.
Methods: Demographic, operative, and postoperative data were collected and analyzed. Follow-up clinical evaluations were conducted
7–10 days, 4 weeks, 6 months, 1 year, and then annually after surgery in all patients.
Results: In the first 2 years of the study, 144 patients were enrolled; nine were lost to follow-up. The mean operating time was 120
min. The mean follow-up was 222 days (range 5–731). Postoperative complications were five infections, three cases of prolonged
ileus, one bowel obstruction, 23 seromas (15 resolved without intervention), and six hernia recurrences. Hospital discharge
occurred a mean of 2.3 days after surgery and return to normal activity a mean of 15 days postoperatively.
Conclusions: Laparoscopic prosthetic ventral hernioplasty avoids the large wound required in open repairs, with attendant complications
and recurrences, and appears safe, especially if an ePTFE mesh is used. Compared with conventional open ventral hernioplasty,
the laparoscopic technique may also allow shorter hospitalization and a quicker return to normal activities after surgery.
Received: 3 April 1997/Accepted: 10 August 1997 相似文献
8.
W. L. Newcomb J. L. Polhill A. Y. Chen T. S. Kuwada K. S. Gersin S. B. Getz K. W. Kercher B. T. Heniford 《Hernia》2008,12(5):465-469
Background Obesity may be the most predominant risk factor for recurrence following ventral hernia repair. This is secondary to significantly
increased intra-abdominal pressures, higher rates of wound complications, and the technical difficulties encountered due to
obesity. Medically managed weight loss prior to surgery is difficult. One potential strategy is to provide a surgical means
to correct patient weight prior to hernia repair.
Methods After institutional review board approval, we reviewed the medical records of all patients who underwent gastric bypass surgery
prior to the definitive repair of a complex ventral hernia at our medical center.
Results Twenty-seven morbidly obese patients with an average of 3.7 (range 1–10) failed ventral hernia repairs underwent gastric bypass
prior to definitive ventral hernia repair. Twenty-two of the gastric bypasses were open operations and five were laparoscopic.
The patients’ average pre-bypass body mass index (BMI) was 51 kg/m2 (range 39–69 kg/m2), which decreased to an average of 33 kg/m2 (range 25–37 kg/m2) at the time of hernia repair at a mean of 1.3 years (range 0.9–3.1 years) after gastric bypass. Seven patients had hernia
repair at the same time as their gastric bypass (four sutured, three biologic mesh), all of which recurred. Of the 27 patients,
19 had an open hernia repair and eight had a laparoscopic repair. Panniculectomy was performed concurrently in 15 patients
who had an open repair. Prior to formal hernia repair, one patient required an urgent operation to repair a hernia incarceration
and a small-bowel obstruction 11 months after gastric bypass. The average hernia and mesh size was 203 cm2 (range 24–1,350 cm2) and 1,040 cm2 (range 400–2,700 cm2), respectively. There have been no recurrences at an average follow-up of 20 months (range 2 months–5 years).
Conclusion Gastric bypass prior to staged ventral hernia repair in morbidly obese patients with complex ventral hernias is a safe and
definitive method to effect weight loss and facilitate a durable hernia repair with a possible reduced risk of recurrence.
No outside funding was received for this study. 相似文献
9.
M. T. T. Knook W. F. Weidema L. P. S. Stassen C. J. van Steensel 《Surgical endoscopy》1999,13(11):1145-1147
Background: Although the recurrence rate for endoscopic herniorraphy is low (0–3%), it is still debatable whether these recurrences should
be corrected laparoscopically or by the conventional method. The aim of this study was to investigate whether these recurrences
can be repaired by means of the laparoscopic approach with acceptable complication and recurrence rates.
Methods: From October 1992 to December 1997, 34 patients with recurrent inguinal hernias at physical examination underwent surgery
at our institutions. All the recurrences occurred following endoscopic inguinal hernia repair with mesh prostheses. The recurrences
were repaired endoscopically using a transabdominal approach. Depending on the size of the defect, a new polypropylene mesh
was used.
Results: Mean surgery time was 69 min. There were no conversions to the anterior approach. After a mean follow-up of 35 months, no
recurrences had been diagnosed.
Conclusion: The transabdominal preperitoneal approach is a reliable technique for recurrent inguinal hernia repair after previous endoscopic
herniorrhaphy.
Received: 7 September 1998/Accepted: 13 October 1998 相似文献
10.
Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh 总被引:30,自引:12,他引:18
Carbajo MA Martín del Olmo JC Blanco JI de la Cuesta C Toledano M Martin F Vaquero C Inglada L 《Surgical endoscopy》1999,13(3):250-252
Background: Despite being one of the most exact indications, laparoscopic treatment of eventrations and ventral hernias is barely known
among the array of laparoscopic techniques.
Methods: A total of 60 patients were assigned at random over a 3-year period to two homogeneous groups to be operated on for major
ventral hernias with mesh. Half of them were operated upon laparoscopically and the rest with open surgery. Early and longer-term
complications were analyzed, as were operative time and postoperative hospital stays.
Results: The two groups were homogeneous in terms of demographic and clinical characteristics. The group that was operated on laparoscopically
presented a lower rate of postoperative and longer-term complications; similarly, surgery time was significantly lower (p < 0.05). Hospitalization time was also significantly lower than in the group undergoing conventional open surgery (p < 0.05).
Conclusions: Laparoscopic treatment of postoperative eventration and primary ventral hernia reduces complications and relapse rates, eliminates
reintervention through mesh infection, reduces operative time, and considerably shortens the hospital stay.
Received: 22 December 1997/Accepted: 18 August 1998 相似文献
11.
Laparoscopic ventral hernia repair with the Goretex Dualmesh: long-term results and review of the literature 总被引:3,自引:3,他引:0
Since 1993 laparoscopy has become a popular technique of repair of ventral hernias. The authors review the long-term results
of a systematic laparoscopic repair of ventral hernias and discuss the current problems compared to open repair. Between 1997
and 2003, 146 patients had a laparoscopic ventral hernia repair using an intraperitoneal Goretex Dualmesh with a 3–5-cm mesh
overlap secured with a combination of nonabsorbable sutures and staples. A total of 155 attempts of laparoscopic repair was
performed with four conversions. The 151 laparoscopic operations were completed in 105.8 min with a mesh implant being of
341 cm2. There were two postoperative deaths and two patients had to be reoperated on. Mesh infection was diagnosed in two cases.
Mean length of stay was 4.9 days. During a follow- up of 26.6 months eight patients (5.8%) developed a recurrence. Laparoscopic
ventral hernia repair is a reproducible technique. Most of the comparative studies have shown an overall lower rate of complications
after laparoscopic repair compared to open but with a 2–4% risk of bowel injury. The two other benefits of the laparoscopy
are reduced postoperative pain and shorter hospital stay. The recurrence rate is usually between 2 and 7% but no difference
has been found compared to open repair. Laparoscopic ventral hernia repair using the Goretex Dualmesh is a reliable operation
with a low rate of conversion to open. Despite the risk of serious bowel injury, laparoscopy achieves as good results as the
mesh open repair on the long term with the benefit of a decreased complication rate and a shorter hospital stay. 相似文献
12.
Laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic patch repair of ventral hernia 总被引:26,自引:10,他引:16
Background: The purpose of this study was to determine whether laparoscopic intraperitoneal polytetrafluoroethylene (PTFE) prosthetic
patch (LIPP) repair of a ventral hernia is superior to open prefascial polypropylene mesh (OPPM) repair in a tertiary care
university hospital in an urban environment.
Methods: Data on 39 consecutive patients undergoing either LIPP repair (n= 21) or OPPM repair (n= 18) were compared.
Results: Findings showed that LIPP repair is characterized by less painful recovery and shorter hospital stay, with 90% of patients
treated successfully as outpatients as compared with 7% in the OPPM group. The total facility costs for the LIPP repair ($8,273
± $2,950) was significantly lower than for the OPPM repair ($12,461 ± $5,987) (p < 0.05). Two serious delayed complications in the LIPP group were treated by reoperation (colocutaneous fistula, mesh infection),
but the higher readmission costs in this group did not negate the overall cost advantage for LIPP repair. In the follow-up
evaluation, 1 hernia recurrence was found in the LIPP repair group, and none in the OPPM group.
Conclusions: Initial experience suggests that LIPP repair has advantages over OPPM repair in terms of decreased hospitalization, postoperative
pain, and disability. Refinements in the technique to reduce complications may make LIPP repair the procedure of choice for
repair of ventral hernias.
Received: 5 June 1998/Accepted: 15 October 1999 相似文献
13.
Background Laparoscopic ventral hernia repair (LVHR) for morbidly obese patients with a body mass index (BMI) exceeding 35 kg/m2 has not been well investigated.
Methods Hernia recurrence was evaluated by surveillance computed tomography. A p value less than 0.05 was considered significant.
Results Between 2003 and 2006, LVHR was attempted for 27 patients with a BMI exceeding 35 kg/m2. There was one conversion to open surgery (3.7%). The 27 patients included 8 men (29.6%) and 19 women (70.4%) with a mean
age of 48 years (range, 33–73 years). The mean BMI was 46.9 kg/m2 (range, 35–70 kg/m2). Nine patients (33%) were superobese (BMI > 50 kg/m2), and five patients (22.7%) underwent emergency LVHR because of small bowel obstruction. Concomitant LVHR with laparoscopic
gastric bypass (LGB) was performed for 13 patients (48%). Primary, incisional, or recurrent incisional ventral hernia was
present in 7 (26%), 15 (55%), and 5 (19%) patients, respectively. A large hernia (>50 cm2) was found in 20 patients (74%). The mesh used was porcine submucosal small intestine extracellular matrix for 15 patients
(57%), Gore-Tex for 9 patients (35%), and Composix for 2 patients (8%). The mean hernia size was 158 cm2 (range, 12–806 cm2), and the mean mesh size was 374 cm2 (range, 117–2,400 cm2). The mean operative time was 190 min (range, 80–480 min), and the mean hospital length of stay (LOS) was 3.6 days (range,
1–11 days). Minor or major complications occurred in seven patients (25.9%), and five patients (18.5%) experienced recurrence
during a mean follow-up period of 14.9 months (range, 3–32 months). Emergency setting, BMI, concomitant LGB, hernia type,
hernia size, and mesh type had no statistically significant effect on operative time, LOS, morbidity, or recurrence rates.
Conclusions For morbidly obese patients, LVHR is safe and effective, but it is associated with higher likelihood of recurrence, and patients
should be appropriately informed.
Presented at the 10th World Congress of Endoscopic Surgery Meeting, Berlin, Germany, September 2006 相似文献
14.
Bursting strength evaluation after different types of mesh fixation in laparoscopic herniorrhaphy 总被引:5,自引:2,他引:3
Background: In laparoscopic inguinal herniorrhaphy, meshes commonly have been fixed with a stapler. Recently, a new mode of fixation
using a helical fastener has been introduced. The purpose of this experimental study was to compare the stability achieved
by various types of mesh fixation.
Methods: In 20 human cadavers, polypropylene meshes 10 × 15 cm in size were fixed in both groins by using either a helical fastener
or a hernia stapler (4.8 mm). The mesh was fixed with 2, 4, and 8 elements and stressed with a dynamometer until the prosthesis
ruptured. A paired and two-sided Student's t-test was used for statistical evaluation.
Results: With the helical fastener, the mesh could be fixed always at the desired site. However, with the stapler, it was not possible
to fix the mesh in the pubic bone or, at times, in the Cooper's ligament. When two fixation elements were used, the mesh fixed
by the helical fastener was able to withstand a median load of 34 N (range 23–53 N), and that fixed by the stapler 7.5 N (range
3–12 N; p < 0.001). When four fixation elements were used, the mesh fixed by the helical fastener was able to withstand 70.5 N (range
53–80 N) and that fixed by the stapler 17.5 N (range 4–25 N; p < 0.001). With the use of eight elements, the mesh fixed by the helical fastener withstood 127 N (range 84–156 N) and that
fixed by the stapler 32.5 N (range 15–59 N; p < 0.001). Thus, in all cases the helical fastener was significantly more stress resistant. The main reason for detachment
of the mesh was tissue disruption or deformation of the fixation elements. Only when a stress of more than 130 N was applied
did the mesh tear in two cases.
Conclusions: The stress-bearing capacity (shear force resistance) of a mesh fixed by a helical fastener is up to four times that of a
mesh fixed by a stapler. Therefore, the helical fastener provides significantly more stable fixation and will be able to protect
the patient better from recurrent hernias caused by mesh migration.
Received: 10 August 1998/Accepted: 26 March 1999 相似文献
15.
Incisional hernias develop in 2%–20% of laparotomy incisions, necessitating approximately 90,000 ventral hernia repairs per year. Although a common general surgical problem, a "best" method for repair has yet to be identified, as evidenced by documented recurrence rates of 25%–52% with primary open repair. The aim of this study was to evaluate the efficacy and safety of laparoscopic ventral and incisional herniorrhaphy. From February 1991 through November 2002, a total of 384 patients were treated by laparoscopic technique for primary and recurrent umbilical hernias, ventral incisional hernias, and spigelian hernias. The technique was essentially the same for each procedure and involved lysis of adhesions, reduction of hernia contents, closure of the defect, and 3–5 cm circumferential mesh coverage of all hernias. Of the 384 patients in our study group, there were 212 females and 172 males with a mean age of 58.3 years (range 27–100 years). Ninety-six percent of the hernia repairs were completed laparoscopically. Mean operating time was 68 min (range 14–405 min), and estimated average blood loss was 25 mL (range 10–200 mL). The mean postoperative hospital stay was 2.9 days and ranged from same-day discharge to 36 days. The overall postoperative complication rate was 10.1%. There have been 11 recurrences (2.9%) during a mean follow-up time of 47.1 months (range 1–141 months). Laparoscopic ventral and incisional hernia repair, based on the Rives-Stoppa technique, is a safe, feasible, and effective alternative to open techniques. More long-term follow-up is still required to further evaluate the true effectiveness of this operation. 相似文献
16.
Katkhouda N Campos GM Mavor E Trussler A Khalil M Stoppa R 《Surgical endoscopy》1999,13(12):1243-1246
We have devised a reproducible approach to the preperitoneal space for laparoscopic repair of inguinal hernias that is based
on an understanding of the abdominal wall anatomy. Laparoscopic totally extraperitoneal herniorrhaphy was performed on 99
hernias in 90 patients at the Los Angeles County–University of Southern California Medical Center, using a standardized approach
to the preperitoneal space. Operative times, morbidity, and recurrence rates were recorded prospectively. The median operative
time was 37 min (range, 28–60) for unilateral hernias and 46 min (range, 35–73) for bilateral hernias. There were no conversions
to open repair, and there was only one conversion to a laparoscopic transabdominal approach. Complications were limited to
urinary retention in two patients, pneumoscrotum in one patient, and postoperative pain requiring a large dose of analgesics
in one patient. All patients were discharged within 23 h. There were no recurrences or neuralgias on follow-up at 2 years.
A standardized approach to the preperitoneal space based on a thorough understanding of the abdominal wall anatomy is essential
to a satisfactory outcome in hernia repair.
Received: 18 November 1998/Accepted: 19 March 1999 相似文献
17.
Stapled and nonstapled laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair 总被引:8,自引:0,他引:8
Background: Controversy exists regarding whether it is necessary to secure the mesh prosthesis during laparoscopic transabdominal preperitoneal
(TAPP) inguinal hernia repair. It is unknown whether stapling the mesh affects recurrence rate, incidence of neuralgia, or
port-site hernia.
Methods: We conducted a prospective randomized trial comparing stapled with nonstapled laparoscopic TAPP inguinal hernia repairs in
a series of 502 consecutive patients undergoing elective inguinal hernia repair at two institutions between January 1995 and
March 1997.
Results: In all, 263 nonstapled and 273 stapled repairs were performed in 502 patients. Patients were evaluated at a median follow-up
of 16 months (range, 1–32 months) by independent surgeons. There was no statistical difference in the incidence of recurrence
(0 to 263 nonstapled, 3 to 273 stapled; chi-square p= 0.09). The overall recurrence rate was 0.6%. There was no significant difference in operative time, port-site hernia, chronic
pain or neuralgia between the two groups.
Conclusion: It is not necessary to secure the mesh during laparoscopic TAPP inguinal hernia repair, allowing a reduction in the size
of the ports.
Received: 28 July 1998/Accepted: 25 November 1998 相似文献
18.
Denise E. Hilling Linetta B. Koppert Richard Keijzer Laurents P. S. Stassen I. Hok Oei 《Surgical endoscopy》2009,23(8):1740-1744
Background Laparoscopic repair of umbilical hernias is usually based on the open underlay procedure in which the mesh is placed intra-abdominally.
To prevent complications such as adhesions, bowel obstruction and fistula formation we developed a new laparoscopic approach,
placing the mesh in the preperitoneal space.
Methods Our laparoscopic approach concerns a standardised procedure with introduction of three intra-abdominally placed trocars. The
ventral abdominal wall is incised in a lengthwise manner approximately 5 cm from the umbilical defect, followed by development
of the preperitoneal space, reposition of the umbilical peritoneal sac and placement and fixation of a ProleneTM mesh. The mesh is secured using transfascial ProleneTM sutures; the peritoneal defect is closed with a running VicrylTM suture. Data on 17 patients with primary umbilical hernias laparoscopically operated on between April 2002 and March 2006
are presented.
Results The 11 men and 6 women had a mean age of 57.8 years (range 37–91 years) and a mean body mass index (BMI) of 30.6 kg/m2 (range 23.7–37.9 kg/m2). Mean hernia size was 1.95 cm (range 1–3 cm), average mesh size was 110 cm2 (range 100–150 cm2). Mean operating time was 85.6 min (range 60–120 min). Mean hospital stay was 2.2 days (range 1–3 days). No major complications
were seen. No recurrences were observed during a mean follow-up of 36.2 months (range 13–62 months).
Conclusions The preperitoneal laparoscopic technique for umbilical hernia repair combines the advantages of a laparoscopic, minimally
invasive, approach, avoiding the potential complications related to intra-abdominal mesh position. 相似文献
19.
Michael J. Rosen 《American journal of surgery》2009,197(3):353-359
Introduction
The ideal prosthetic material for ventral hernia repair has yet to be described. Each prosthetic material has unique advantages and disadvantages in terms of tissue ingrowth, adhesion formation, and shrinkage profiles. Polyester-based mesh has shown minimal shrinkage and excellent tissue ingrowth in animal models. However, the macroporous, braided nature of this material has raised several concerns regarding the incidence of infections, fistulas, and bowel obstructions. We have reviewed our experience with polyester-based mesh for the repair of ventral hernias.Methods
All patients undergoing ventral hernia repair at the Case Comprehensive Hernia Center at University Hospitals of Cleveland from December 2005 to April 2008 were included. Laparoscopic cases underwent intraperitoneal placement of a polyester-based mesh with a collagen hydrogel anti-adhesive barrier. The mesh was sized for at least 4 cm of fascial overlap, and transfascial fixation sutures and titanium spiral tacks were used routinely to secure the mesh to the abdominal wall. Those cases deemed inappropriate for laparoscopic ventral hernia repair underwent open repair. Open ventral hernia repairs were performed using a retrorectus repair, placing the mesh in an extraperitoneal position. Unprotected polyester mesh was used in these cases. Pertinent data included patient demographics, surgical details, postoperative outcomes, and long-term follow-up evaluation.Results
During the study period 109 patients underwent ventral hernia repair with polyester mesh. Seventy-nine patients had a laparoscopic repair, and 30 patients had an open repair. The mean age was 57 years, with a mean body mass index of 33 kg/m2, and American Society of Anesthesia score of 2.6. The patients had undergone 2.1 prior abdominal surgical procedures, and 42 patients had recurrent hernias. Surgical details for the laparoscopic repair and open repair were as follows: mean defect size, 116 versus 403 cm2; mesh size, 367 versus 1,055 cm2; and surgical times, 132 versus 170 minutes, respectively. The average hospital stay was 4.2 days for the laparoscopic repair and 5.8 days for the open repair groups. With a mean follow-up period of 14 months (range, 2-28 mo) in the laparoscopic repair group, 1 patient (1.4%) developed a mesh infection (with a history of a prior methicillin-resistant Staphylococcus aureus mesh infection), 1 patient (1.4%) developed a small-bowel obstruction remote to the mesh on re-exploration, and there were no fistulas. With a mean follow-up period of 11 months (range, 2-21 mo) in the open repair group, 3 wound infections (13%) occurred, 2 involved the mesh, which was salvaged with local wound care in 1, and required partial mesh resection in the other, and there were no bowel obstructions or fistulas during the follow-up evaluation.Conclusions
This study shows that in this complex group of patients, polyester mesh placed during ventral hernia repair results in acceptable infection rates, and no direct bowel complications or fistulas. Given the macroporous nature of the mesh, each case of infection was treated successfully with local wound measures or partial mesh resection. Polyester-based meshes with an anti-adhesive barrier appear safe for intraperitoneal placement. 相似文献20.
Background: Giant prosthetic reinforcement of the visceral sac (GPRVS), an open preperitoneal mesh repair, is a very effective groin
hernia repair. Laparoscopic transabdominal preperitoneal repair (TAPP), based on the same principle, is expected to combine
low recurrence rates with minimal postoperation morbidity.
Methods: Seventy-nine patients with 93 recurrent and 15 concomitant primary inguinal hernias were randomized between GPRVS (37 patients)
and TAPP (42 patients). Operating time, complications, pain, analgesia use, disability period, and recurrences were recorded.
Results: Mean operating time was 56 min with GPRVS versus 79 min with TAPP (p < 0.001). Most complications were minor, except for a pulmonary embolus and an ileus, both after GPRVS. Patients experienced
less pain after a laparoscopic repair. Average disability period was 23 days with GPRVS versus 13 days with TAPP (p= 0.03) for work, and 29 versus 21 days, respectively (p= 0.07) for physical activities. Recurrence rates at a mean follow-up of 34 months were 1 in 52 (1.9%) for GPRVS versus 7
in 56 (12.5%) for TAPP (p= 0.04). Hospital costs in U.S. dollars were comparable, with GPRVS at $1,150 and TAPP at $1,179.
Conclusions: Laparoscopic repair of recurrent inguinal hernia has a lower morbidity than GPRVS. However, laparoscopic repair is a difficult
operation, and the potential technical failure rate is higher. With regard to recurrence rates, the open preperitoneal prosthetic
mesh repair remains the best repair.
Received: 14 April 1998/Accepted: 28 May 1998 相似文献