腹腔镜下腹壁巨大切口疝修补术的临床分析

目的 探讨腹腔镜下应用补片修补腹壁切口疝的手术方法及临床效果.方法 回顾性分析41例腹壁切口疝行腹腔镜下补片修补术患者的临床资料.结果 38例均顺利完成手术, 3例中转开腹.手术时间 78～186 min,平均 95 min.术后疼痛轻微,术后排便、排气时间 25～41 h,平均 32 h.术后第 2 d进食.术后住院 5～7 d,平均 6 d.41例随访 6～16个月,平均 9个月,未见疝复发.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.     

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。     

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。     

��ǻ���¸����п����޲���41����Ч����

目的评价腹腔镜下腹壁切口疝修补术的长、短期疗效。方法回顾性分析2006年3月至2011年7月苏州大学附属第二医院普外科41例行腹腔镜下腹壁切口疝修补术的临床资料。结果 41例切口疝均在腹腔镜下完成修补,手术时间45～150min,平均60min,术后住院时间3～16d,平均6d,术后随访2～65个月,平均25.6个月。发生血清肿4例,术后疼痛8例(术后3～6周缓解),补片感染1例,复发2例。结论腹腔镜腹壁切口疝修补术具有创伤小、恢复快、并发症少及复发率低等优点,是一种安全有效的手术方式。     

腹腔镜下腹壁切口疝修补术20例

目的 探讨腹腔镜治疗腹壁切口疝的安全性及有效性.方法 回顾性分析2009年6月至2011年9月20例腹壁切口疝患者的资料.其中男14例,女6例,年龄26 ～ 76岁,平均57.3岁.距离上次手术时间间隔为4～26个月,平均7个月.腹正中切口13例,侧腹部切口7例.有2例为缝合修补术后复发病例.结果 所有患者均采用复合补片进行修补,腹壁缺损大小4cmx5cm～ 10cm×13 cm.手术时间40～ 170 min,平均100 min.术后所有患者切口Ⅰ期愈合,术后补片上方疝囊内积液5例,经局部穿刺抽吸并加压包扎后治愈.术后修补区域腹壁疼痛1例,给予口服美洛昔康片对症处理,于术后3个月内逐渐消失.术后住院时间4～13d,平均7d.18例患者获得随访,随访6～30个月,平均15个月,1例复发.结论 腹腔镜下复合补片修补腹壁切口疝具有损伤小、术后疼痛轻、并发症少、恢复快等优点,值得推广.     

腹腔镜下腹壁巨大切口疝修补术的临床应用

目的探讨腹腔镜下应用补片修补巨大腹壁切口疝的手术方法及临床效果。方法分析25例应用腹腔镜下补片修补腹壁巨大切口疝(腹壁缺损长径为12~25cm,宽9~18cm,缺损面积108~451cm2)患者的临床资料。结果21例(84.0%)顺利完成腹腔镜下腹壁切口疝修补术,4例(16.0%)因肠管与腹壁粘连紧密而中转开腹。手术时间78~186(平均95)min。术后住院5~8d,平均6.5d。术后疼痛达3个月以上8例(32.0%),经治疗后缓解;浆液肿9例(36%)。无切口感染和肠瘘发生;无手术死亡。全组患者随访6~25(平均11)个月,无切口疝复发。结论腹腔镜下修补腹壁巨大切口疝是一种安全、有效的方法,对腹腔粘连重分离困难者应及时中转开腹。     

腹腔镜下生物补片修补成人脐疝

目的 探讨腹腔镜下生物补片修补成人脐疝的方法及效果.方法 2003年1月至2008年10月在腹腔镜下用生物补片修补脐疝21例,其中男6例,女15例,年龄36～73岁,平均56岁.疝环直径3～7.5 cm,平均5.2 cm.手术均采用全麻,术前1 d行清洁肠道准备,术前30 min预防性静脉应用抗生素1次.选用巴德Composix E/X复合补片,根据疝环大小选取适当规格补片,要求其边缘超过疝环缺损3～5 cm.将补片置入腹腔后平铺,聚丙烯而朝向腹壁,其中心点对准疝环中心点,用钉枪将补片固定于腹壁上,内外2圈,内圈沿疝环,外圈沿补片边缘.结果 所有手术均在腹腔镜下顺利完成,无中转开腹.手术时间30～96 min,平均52 min.术后出现明显腹胀2例,术后2～3 d自行缓解;1例术后出现修补区域腹壁的明显疼痛不适感,给予对症处理,1周后疼痛逐渐缓解消失.无浆液肿.无切口及补片感染.术后住院时间3～8 d,平均4.2 d.随访3个月至5年,平均32个月,无肠梗阻,无复发病例.结论 腹腔镜下生物补片修补成人脐疝是安全有效的.     

腹腔镜下修补老年患者腹壁切口疝24例体会

探讨腹腔镜下修补老年患者腹壁切口疝的疗效和体会。回顾性分析兰州军区兰州总医院普外科2010年6月—2013年6月对24例老年腹壁切口疝患者(年龄均≥60岁)使用腹腔镜下疝修补术的临床资料。其中23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例因肠管与腹壁及疝环致密粘连而中转为开放切口疝修补术。手术时间55~170 min,平均105 min。疝环内径3~11cm,平均8 cm。术后住院6~14 d,平均9 d。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;术后补片上方疝囊内积液2例,经局部穿刺抽吸并加压包扎后治愈;1例手术区明显疼痛超过1个月,经口服镇痛药物等保守治疗治愈。术后20例患者获得随访,随访6~32个月(平均18个月),1例复发,其余恢复良好,无局部不适。腹腔镜下修补老年患者腹壁切口疝这一术式安全可靠,值得临床推广。     

腹腔镜下复合补片修补耻骨上切口疝(附25例报道)

目的总结腹腔镜下耻骨上切口疝修补的手术方法及效果。方法回顾性分析2007年3月至2010年10月期间笔者所在科室25例行腹腔镜下耻骨上切口疝修补术患者的临床资料。男13例,女12例;年龄35～83岁,中位年龄52岁;其中2例是复发疝。疝缺损下缘距耻骨弓距离均小于5 cm。在直视下采用螺旋钉枪将补片固定到腹壁上,补片下边缘须低于耻骨弓2 cm并将其固定到耻骨弓及双侧的耻骨梳韧带上。结果 25例患者均成功完成腹腔镜下切口疝修补,无中转开腹。疝缺损最大径为6.1～12.5 cm,平均9.5 cm。手术时间为90～180 min,平均128 min。总并发症发生率为28%(7/25)。包括术中膀胱损伤1例;术后补片上方浆液肿4例,经局部穿刺抽吸后消失;术后修补区域腹壁疼痛2例,未行特殊处理于术后1个月内逐渐缓解并消失。22例患者获随访,随访率为88%,随访时间为6～48个月,平均30个月,1例于术后2个月复发,复发率为4%。结论腹腔镜下耻骨上切口疝修补是一种安全有效的方法,其网片重叠缺损边缘至少超过5 cm,网片下边缘必须在直视下固定到双侧耻骨梳韧带上,这样可以增加固定的强度并降低修补术后复发率。     

腹腔镜腹壁切口疝补片修补术的应用体会

目的：探讨腹腔镜腹壁切口疝补片修补术的临床应用价值及安全性。方法：2005年8月至2006年10月我院为8例腹壁切口疝患者使用自膨胀式聚丙烯-膨化聚四氟乙烯双面复合型补片行腹腔镜腹壁切口疝修补术,其中2例联合行胆囊切除术。结果：8例手术均获成功,手术时间55～150min,平均85min,无手术死亡病例及并发症发生,患者术后8～24h后下床活动,1—2d排气,术后疼痛轻,2—3d后完全缓解,3—7d（平均4d）患者顺利康复出院。随访12～24个月无复发。结论：腹腔镜腹壁切口疝修补术安全可靠,具有创伤小、术后康复快、并发症少、不增加手术穿刺孔、可完成联合手术等优点,临床应用前景广阔。     

Laparoscopic repair of large incisional hernias

Incisional hernias after abdominal operations are a significant cause of long-term morbidity and have been reported to occur in 3 to 20 per cent of laparotomy incisions. Traditional primary suture closure repair is plagued with up to a 50 per cent recurrence rate. With the introduction of prosthetic mesh repair recurrence decreased, but complications with mesh placement emerged ushering in the development of laparoscopic incisional herniorrhaphy. The records of patients who underwent laparoscopic incisional hernia repair between June 1, 1995 and September 1, 2001 were reviewed. Patient demographics, hernia defect size, recurrence, operative time, and procedure-related complications were evaluated. Fifty patients (22 male and 28 female, mean age 57 years with range of 24-83) were scheduled for laparoscopic incisional hernia repair between June 1, 1995 and September 1, 2001. The average patient was obese with a mean body mass index of 35.8 kg/m2 (range 16-57 kg/m2). Two patients (4%) had primary ventral hernias. Forty-eight patients (96%) had incisional hernias with 22 (46%) of these previously repaired with prosthetic mesh. Mean defect size was 206.1 cm2 (range 48-594 cm2). The average mesh size was 510.2 cm2 (range 224-1050 cm2). Gore-Tex DualMesh and Bard Composite Mesh were used in 84 and 16 per cent of the repairs, respectively. Mean operating time was 97 minutes. There were no deaths. Complications were seen in 12 per cent patients (six occurrences) and included two small bowel enterotomies, a symptomatic seroma requiring aspirate, a mesh reaction requiring a short course of intravenous antibiotics, and trocar site pain (two patients). There were no recurrences during a mean follow-up of 41 months (range 3-74 months). We conclude that laparoscopic incisional herniorrhaphy offers a safe and effective repair for large primary and recurrent ventral hernia with low morbidity.     

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。     

Laparoscopic treatment of abdominal wall hernias: prosthesis material comparison

Hernia is due to abdominal wall weakening. This allows the contents of the abdomen to protrude from normal boundaries. Hernias are repaired by implanting a sterile surgical mesh to strengthen the weakened abdominal wall. Aim of this study is to compare the results obtained by bard Composix? L/P mesh or Dualmesh Plus Gore? implanting. The mesh has various beneficial characteristics. It is a reinforcing material for the abdominal wall, even when in the direct contact with the intestinal tract does not cause adhsion problems. The use of biocompatible materials is necessary in laparoscopic hernia repair. e-PTFE prosthesis and Dual Mesh? were the first to be used for laparoscopic treatment of the abdominal wall defects. These prosthesis are the result of many improvements, actually they are 1-mm thick and the two surfaces have different characteristics. Compound meshes are composed by e-PTFE and polypropylene with different percentage of the two materials and methods of interactions. The incidence of early complications were poor in relation to both types of implants, only seroma cases e-PTFE treated showed a prevalence of complication, in agreement with literature. About relapses in our experience we found that e-PTFE cases were predominantly. Dual Mesh? has better adaptability than Bard Composix?, which allows easier placement of the prosthesis as well as a better adaptation to the wall surface. The Bard Composix?, thanks to rigidity due to the polypropylene component has better handling than the Dual Mesh?, as it promotes a rapid and easy deployment of the prosthesis inside the abdominal cavity, favoring its positioning. The use of both prosthesis depends also on the experience specific to each operator, moreover, a rigorous surgical technique remains fundamental for the application of the mesh used.     

The feasibility of adopting laparoscopic incisional hernia repair in general surgery practice: early outcomes in an unselected series of patients

A laparoscopic approach to incisional hernia repair has been shown to be safe and effective in selected patients. We report our early outcomes following laparoscopic ventral/incisional hernia repair (LVHR) in an unselected series of patients encountered in general surgery practice. All patients referred with incisional hernia were offered a laparoscopic repair using prosthetic mesh. Patients were not excluded from laparoscopic approach on the basis of age, previous surgery, defect size, intraperitoneal mesh, body mass index (BMI), comorbidities, or abdominal wall stomas. We followed 28 consecutive patients who underwent LVHR (17 primary, 11 recurrent hernias). Laparoscopic repair was completed in 27 patients with a mean operative time of 141.6 +/- 11.9 minutes. There were no intraoperative complications. The mean size of the abdominal wall defects was 153.4 +/- 27.5 cm and the mean mesh size was 349.2 +/- 59.1 cm. The mean hospital stay was 3.7 +/- 0.3 days. Nine patients developed large wound seromas; all spontaneously resolved. Our experience suggests that LVHR is feasible as a primary approach to most incisional hernias encountered in general surgery practice.     

An unusual cause of chronic anemia and abdominal pain caused by transmural mesh migration in the small bowel after laparoscopic incisional hernia repair

Mesh repair of incisional hernia is recommended to reduce recurrence. Recognized complications include mesh infection and fistula. Composite meshes with antiadhesive barriers were designed for intraperitoneal placement to reduce adhesion formation and fistulization to the viscera. Transmural mesh migration is a rare complication of hernia repair with composite mesh and can be present with a variety of symptoms. We report an interesting case of transmural mesh migration into the small bowel presenting with chronic microcytic anemia and abdominal pain 5 years after laparoscopic incisional hernia repair with a composite polypropylene/ePTFE mesh.     

Incisional hernia—comparison of mesh repair with Cardiff repair: an university hospital experience

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.     

Mesh incisional herniorrhaphy increases abdominal wall elastic properties: a mechanism for decreased hernia recurrences in comparison with suture repair

BACKGROUND: An improved understanding of load-bearing soft tissue repair suggests that the mechanism for the improved outcomes after alloplastic incisional herniorrhaphy involves more than simple tissue replacement or material strength. We test the hypothesis that postrepair abdominal wall elastic properties are most predictive of successful abdominal wall reconstruction. METHODS: A rodent model of chronic incisional hernia formation was used. Midline incisional hernias were repaired primarily with suture (n = 24) or polypropylene mesh (n = 24). Rodents were sacrificed at serial postoperative time points over 60 days. Intact abdominal wall strips were cut perpendicular to the wound for tensiometric analysis. Biopsies of wound provisional matrix were obtained for biochemical analysis. RESULTS: Recurrent incisional hernia formation was significantly decreased in the mesh-repair group, compared with the suture-repair group (5/24 vs 14/24, P = .02). Mesh-repaired abdominal walls demonstrated significantly more elongation (P < .01) and less stiffness (P < .01). Toughness was equal between wounds, although the suture-repaired wounds had increased recovery of tensile strength (P < .01). There were no significant differences in collagen deposition after postoperative day 7. CONCLUSIONS: Mesh incisional herniorrhaphy increases abdominal wall elastic properties as measured by increased elongation and reduced stiffness. Increased abdominal wall elasticity after incisional hernia repair in turn results in lower recurrence rates.     

腹腔镜下造口旁疝补片修补术

目的探讨腹腔镜下造口旁疝补片修补术的效果。方法2004年9月-2005年12月，对7例造口旁疝进行腹腔镜补片修补术。结果6例修补成功，1例因腹腔内广泛致密粘连而中转为剖腹缝合修补。手术时间45-180min，平均109min。疝环直径4-6cm，平均5．6cm。术后暂时性腹胀2例；5例修补区域腹壁疼痛，3周内明显缓解；4例血清肿，经2-4次穿刺抽液并加压包扎后治愈。无血肿发生，未发生与手术相关的感染。术后住院时间3-8d，平均5．1d；术后随访2-15个月，平均8．3月，未见复发。结论腹腔镜造口旁疝补片修补术技术上安全、可行，早期的临床疗效较理想。     

Incisional herniorrhaphy with intraperitoneal composite mesh: a report of 95 cases

Incisional herniorrhaphy remains a formidable challenge to the general surgeon. Recurrence rates after primary repair are reported between 31-54 per cent while tension-free repairs with prosthetic mesh have lowered this rate to 10 per cent. Repairs with composite mesh (polypropylene/ePTFE) have been gaining in popularity due to the ease of mesh placement in the intraperitoneal location. This paper reviews our experience with composite repairs at a teaching community hospital. A retrospective chart review was performed which evaluated all patients undergoing abdominal incisional hernia repairs over a 4(1/2)-year period. The data were analyzed for mortality, recurrence, infection, subsequent bowel obstruction, and fistula formation. Two hundred twenty-one incisional herniorrhaphies were identified in the resident database of which 95 were repaired with Composix mesh (Bard Surgical, Cranston, RI) in the intraperitoneal position. There were two (2%) recurrences and eight (8%) infections. Fistulization to the small bowel from exposed polypropylene occurred in one patient. There were no bowel obstructions. One postoperative death occurred secondary to pulmonary embolus. Mesh removal was required in all infected cases, and there was a high incidence (63%) of methicillin-resistant Staphylococcus aureus (MRSA). Our findings parallel the low recurrence rate following prosthetic repair. We have reported a higher than expected infection rate particularly with MRSA. Although repairs with Composix mesh are highly successful in regard to recurrence, the high infection rate and resulting morbidity needs to be further evaluated.