复合切口疝补片修补腹壁巨大切口疝30例分析

目的 分析应用聚丙烯和聚四氟乙烯复合切口疝补片修补腹壁巨大切口疝的临床效果，讨论应用复合补片的手术方法和经验体会。方法 1999年5月～2005年5月应用复合切口疝补片修补腹壁巨大切口疝30例，其中皮下置片法12例，腹腔内法18例。平均随访期36个月。结果 术后复发2例，占6．7％。切口并发症33．3％，切口感染5例，均为皮下法；皮下积液5例，其中皮下法3例，腹腔内法2例。结论 腹壁巨大切口疝，特别是传统法难以修补的，可应用聚丙烯和聚四氟乙烯复合补片修补。应用腹腔内法及正确的术中、术后处理可减少术后并发症的发生。     

剖腹腹腔内补片修补腹壁切口疝21例体会

目的 探讨、总结剖腹腹腔内补片修补腹壁切口疝的经验.方法 2007年2月至2010年3月收治的21例腹壁切口疝采用复合补片进行开放式完全腹腔内修补.结果 1例术后3d死于腹腔室间隔综合征,其余20例无并发症发生,随访 6个月～3年无复发.结论 腹壁切口疝采用复合补片进行开放式完全腹腔内修补方法安全、有效     

开放式完全腹腔内修补治疗巨大腹壁切口疝10例

目的探讨用Gore—Tex补片开放式完全腹腔内修补治疗巨大腹壁切口疝的疗效。方法用Gore．Tex补片开放式完全腹腔内修补治疗巨大腹壁切口疝10例，其中初发切口疝9例，复发切口疝1例。结果9例一期愈合，1例发生创面局限性积液，经穿刺负压引流处理后治愈，随访10个月至2年，无复发病例。结论用Gore—Tex补片开放式完全腹腔内修补治疗巨大腹壁切口疝经济，安全，有效，感染风险降低。     

应用聚丙烯和e-PTFE复合补片修补腹壁巨大切口疝

目的回顾性分析应用聚丙烯和e鄄PTFE复合补片修补腹壁巨大切口疝的效果,介绍腹腔内应用复合补片的方法和经验。方法1999年5月至2003年12月应用复合补片修补腹膜难以对合的腹壁巨大缺损22例,其中补片置于皮下12例,腹腔内10例。平均随访期39个月。结果手术后切口并发症的发生率为41%(9/22),1例修补术后复发,占4.6%。应用皮下法发生切口感染3例,其中1例因严重感染而将补片取出;切口处皮下积液2例。应用腹腔内法者中仅2例发生切口皮下少量积液。结论腹壁巨大切口疝,特别是难以关闭腹膜的病例,可应用聚丙烯和e鄄PTFE复合补片进行修补。应用腹腔内置补片法并辅以正确的术后处理可使局部并发症明显减少。     

老年腹壁切口疝的腹腔镜下修补术

目的 探讨腹腔镜下应用补片行老年腹壁切口疝修补术的方法、安全性及临床效果。方法 2004年11月至2006年6月对17例老年切口疝患者行腹腔镜下应用补片切口疝修补术。结果 16例腹腔镜下行腹腔粘连松解和补片固定,顺利完成切口疝修补手术,1例因肠管与腹壁粘连紧密而中转开腹修补术。手术时间65～132min,平均95min。术后恢复排便、排气时间平均为31h,术后住院5～7d。术后并发症：疼痛3个月以上者3例,浆液肿5例,穿刺口感染1例,均经保守治疗后好转,无手术死亡和肠瘘发生。随访7～26个月（平均13个月）,未见切口疝复发。结论 腹腔镜下行腹腔内粘连松解,采用缝合器和缝线贯穿腹壁固定补片修补老年腹壁切口疝安全、有效。     

开放式腹壁大切口疝和巨大切口疝补片修补术

目的探讨腹壁大切口疝和巨大切口疝治疗经验。方法对我院采用补片行开放式腹壁大切口疝和巨大切口疝修补术的51例患者临床资料进行回顾性分析。结果采用肌前补片修补法3例,肌肉间补片修补法3例,肌后腹膜前补片修补法39例,腹腔内补片修补法6例。手术时间109~195 min,平均135.2 min;术中出血15~90 ml,平均35.6 ml;术中无血管和内脏损伤等并发症。术后3~7 d(平均4.9 d)下床活动;住院时间7~19 d,平均9.7 d。2例患者术后出现浆液肿,经穿刺抽吸、负压吸引和腹带加压包扎后治愈。51例患者随访12~36个月(平均24.5个月),3例(5.9%)患者复发,后行开放式腹腔内补片修补手术,恢复良好,无再复发。所有病例无慢性疼痛。结论应用补片行开放式腹壁大切口疝和巨大切口疝修补术是一种安全、可靠的方法,复发率低。     

应用合成补片进行老年患者腹壁切口疝的完全腹腔内修补

目的 探讨老年腹壁切口疝患者的完全腹腔内修补术的治疗方法和疗效.方法 回顾性分析我院2001年7月至2008年8月间收治的73例应用合成补片进行完全腹腔内修补术的老年患者的I临床资料.结果 所有患者无手术中或手术后死亡,术后复发率1.4%.结论 完全腹腔内修补方法的手术适应证宽、复发率低,应用于老年腹壁切口疝患者可以得到相当安全可靠的疗效.     

腹腔镜下腹壁切口疝修补术

目的探讨腹腔镜下应用补片行腹壁切口疝修补术的方法、安全性及临床效果。方法2004年9月至2007年6月对56例切口疝（腹壁缺损长径7～19cm,宽径4～12cm）的患者行腹腔镜下应用补片行切口疝修补术。结果55例腹腔镜下行腹腔粘连松解和补片固定,顺利完成切口疝修补手术,1例因肠管与腹壁粘连紧密而中转开腹修补术。手术时间60～135min,平均92min。肠功能恢复早,术后排便、排气时间平均为31h,术后住院5～7d。术后并发症：术后疼痛达3个月以上者有9例,浆液肿8例。无手术死亡和肠瘘发生。随访16～28个月,平均19个月,未见切口疝复发。结论腹腔镜下行腹腔内粘连松解、采用缝合器和缝线贯穿腹壁固定补片来修补腹壁切口疝是一种安全、有效的微创方法,值得临床推广应用。     

复合补片修补腹壁切口疝十例的临床分析

目的评价应用复合补片腹膜内置入修补腹壁切口疝的效果。方法2003年11月至2005年6月应用复合补片修补腹膜难以对合的腹壁切口疝10例，均采用腹膜内置入修补法。结果所有患者均顺利恢复，手术后早期未发生切口感染、皮下血肿和血清肿等并发症。10例患者术后均得到随访，随访6～24个月，平均18个月。随访期内未发现肠梗阻、窦道形成和肠瘘等远期并发症和切口疝复发，10例患者均局部感觉良好。结论应用复合补片腹膜内置入修补切口疝是一种安全、有效的方法。     

腹腔镜下腹壁切口疝修补术(附41例报告)

目的探讨腹腔镜下采用聚丙烯和膨化聚四氟乙烯复合补片（Bard Composix Mesh）修补腹壁切口疝的效果。方法2004年10月～2005年8月，对41例切口疝（腹壁缺损长径3～25cm，宽径3～18cm）腹腔镜下用超声刀进行腹腔内粘连松解和采用强生疝修补用缝合器行补片固定修补术。结果41例均顺利完成，无中转开腹。手术时间60～182min，平均85min。术后疼痛轻微，术后排便、排气时间25～41h，平均32h。术后第2天进食。术后住院5～7d，平均6d。41例随访6～16个月，平均9个月，未见切口疝复发。结论腹腔镜下采用复合补片修补腹壁切口疝是一种安全、有效的方法，值得临床推广应用。     

Bard Composix补片修补巨大切口疝临床应用

目的 总结应用Bard Composix补片修补4例巨大切口疝的临床经验。方法 使用美国巴德公司的Composix补片对4例巨大腹壁切口疝进行修补术治疗。结果 4例病人均无并发症,随访1～11个月无复发。结论 Composix补片修补巨大切口疝具有安全、创伤小、恢复快的优点,是治疗切口疝的理想术式。     

Laparoscopic incisional and ventral hernia repair (LIVH): an evolving outpatient technique.

BACKGROUND AND OBJECTIVES: The contemporary results of open incisional and ventral hernia repair are unsatisfactory because of high recurrence rates and morbidity levels. Laparoscopic repair of ventral and incisional hernias (LIVH) can be accomplished in a simple, reproducible manner while dramatically lowering recurrence rates and morbidity. METHODS: One hundred consecutive patents underwent laparoscopic repair of their ventral and incisional hernias over a 27-month period. Composix mesh and Composix E/X mesh (Davol Inc., Cranston, RI) were utilized for the repairs. Transfixion sutures were not used. RESULTS: All repairs were completed laparoscopically. No conversions to open techniques were necessary. No postoperative infections have been observed. One recurrent hernia was identified and subsequently repaired with the same technique. CONCLUSIONS: LIVH can be accomplished with a dramatic reduction in recurrence rates and morbidity. The technique for this repair is still in a state of evolution. The construction and handling characteristics of this particular type of mesh have allowed us to eliminate transfixion sutures and to simplify the repair technique while maintaining a very low recurrence rate.     

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??Therapeutic effect of open incisional hernia mesh repair: A report of 636 cases HU Xing-chen??LI Shao-jie??TANG Jian-xiong, et al. Center of Treatment and Training for Hernia and Abdominal Wall Surgery??Huadong Hospital Affiliated to Fudan University??Shanghai 200040??China
Corresponding author??TANG Jian-xiong??E-mail??johnxiong@china.com
Abstract Objective To analyze the clinical efficacy of open incisional hernia mesh repair. Methods The clinical data of 636 cases of open incisional hernia mesh repair performed from December 2002 to September 2013 in Huadong Hospital Affiliated to Fudan University were analyzed retrospectively. According to the different types of incisional hernia??different patch and different surgical method were used. Recurrence??wound infection??chronic pain??patch infections??intestinal fistula, seroma and other complications were observed and analyzed. Results There were 5 cases of death (0.8%) after operation. There were 26 cases (4.1%) of recurrence??41 cases (6.4%) of wound infection or fat liquefaction??5 cases (0.8%) of chronic pain??10 cases (1.6%) of patch infection??12 cases (1.9%) of intestinal fistula and 6 cases (0.9%) of seroma. Recurrence rate of IPOM was lower than that of Sublay. Compared with Proceed??GORE-TEX DualMesh Composix or Kugel patch had high incidence of wound infection (P<0.01)??while using Composix E / X Mesh patch had no difference in incidence of wound infection (P>0.05). Incidence of patch infection of GORE-TEX DualMesh was significantly higher than that of Proceed (P<0.01). Conclusion Open incisional hernia mesh repair is a safe and effective technique. It would like to use different operations for different patients.     

Abdominal incisional hernia repair. Intraperitoneal prosthetic technique using Bard Kugel Composix Mesh

The treatment of choice for incisional hernia is prosthetic repair Extensively debated issues are the materials used and the implantation site of the mesh. The authors report their personal experience with 17 cases operated on by placement of an intraperitoneal Bard Kugel Composix Mesh. From May 2003 to August 2005, 10 female and 7 male patients with incisional hernia, aged from 43 to 76 years (mean age: 65 years), were submitted to intraperitoneal prosthetic mesh implantation and monitored over a follow up period ranging from 2 to 28 months (median: 15 months). The technical aspects and the rationale for this approach are described. The advantages of this procedure are its simplicity and rapidity of execution, a reduced incidence of complications, and good tolerance in terms of patient pain and comfort. The mesh was removed in one case owing to infection of the prosthesis. Follow-up to date has revealed no instances of recurrence.     

腹壁疝补片修补术后补片感染14例分析

目的：探讨疝修补术后补片感染的原因、预防及治疗方法。方法回顾性分析1997年12月至2013年12月我院收治的14例使用补片修补腹壁疝术后补片感染的临床资料。其中腹股沟疝平片修补1例,腹股沟疝腹膜前间隙修补11例,切口疝1例,使用巴德Composix补片开放式腹腔内补片修补;造口疝1例,腹壁肌肉前置入补片修补。根据感染程度、材料不同采用相应的治疗方法,4例去除补片,10例开放换药。结果全组患者均治愈出院,无围手术期死亡。手术过程中无大出血和膀胱损伤。随访时间8～64个月,1例切口疝术后复发。结论产生补片感染的原因很多,预防感染最为重要。一旦发生补片感染,治疗方法应个体化,有效引流及合理运用抗生素可解决多数聚丙烯（PPM）补片感染,唯膨体聚四氟乙烯（ePTFE）补片需完全去除。     

Laparoscopic sutured closure with mesh reinforcement of incisional hernias

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.     

Intraperitoneal tension-free repair of small midline ventral abdominal wall hernias with a Ventralex hernia patch: initial experience in 51 patients

Midline ventral hernias are common. Tension-free mesh repair of ventral hernias is becoming popular due to the high recurrence rate with conventional techniques. We have used an open intraperitoneal technique using the Bard Ventralex hernia patch in midline ventral hernias (≤3 cm). Fifty-one patients were treated (34 males and 17 females) with a mean age of 52.4 years (range 18–82). Forty-three patients were day cases. Operative times, analgesic use, overnight hospital stay and postoperative complications were recorded prospectively. The mean operative time was 30 min (range 10–68). Thirty-six patients required mild/moderate postoperative analgesia. Two patients had minor wound infections and one had seroma. There was one recurrence. Our early experience suggests that Ventralex hernia patch repair of small midline ventral hernias can be performed as a day case with minimal postoperative complications.     

ROBotic Utility for Surgical Treatment of hernias (ROBUST hernia project)

We describe the evolution in hernia repair approaches in our practice during the first 3 years of adopting robotic assisted laparoscopic surgery. For inguinal hernia repair, we began using the robotic platform for complex hernias, and the use of open repair decreased from 17% to 6%. For primary ventral hernias, open procedures decreased from 59% to 10% and for incisional ventral hernias, from 48% to 11%. Moreover, a large shift in mesh position for ventral hernias was seen, with an increase of the retromuscular position from 20% to 82% and a decrease of intraperitoneal mesh position from 48% to 10%.The robotic platform seems to hold a significant potential for complex inguinal hernias, in addition to ventral and incisional hernias which require component separation. A shorter hospital stay and less postoperative complications might make the adoption of the robotic platform for abdominal wall surgery a valuable proposition.     

腹腔镜下修补70岁以上患者腹壁切口疝(附8例报道)

目的初步探讨并总结腹腔镜下腹腔内置补片法修补70岁以上老年患者腹壁切口疝的临床经验。方法回顾性分析了我院2005年7月至2008年7月期间实施的8例腹腔镜下腹腔内置补片法修补70岁以上老年患者腹壁切口疝的临床资料。结果8例中有1例因腹腔粘连严重而中转开腹手术,其余7例均成功完成腹腔镜下疝修补手术;手术时间50～180min,平均105min;术后1例发生高碳酸血症导致昏迷,经呼吸机辅助呼吸24h后好转;1例发生血清肿,1例术区明显疼痛超过1个月,均经保守治疗治愈;住院时间7～14d,平均9.5d。术后随访12～36个月(平均26.5个月)无复发,无局部不适。结论腹腔镜下腹腔内置补片法修补70岁以上患者的腹壁切口疝是安全、可行的,且具有微创、恢复快等优点,但必须注意围手术期处理及手术技巧。