Mesh在腹股沟疝修补中的应用

目的 探讨腹股沟疝的修补方法。方法 对18例腹股沟疝采用聚丙烯网片(Mesh)进行无张力修补。结果 18例手术均顺利，术后痛苦小、并发症少、住院时间短，随访11～23月，无复发。结论 采用Mesh修补腹股沟疝符合解剖生理，具有无张力、痛苦小、恢复快等特点。     

Proceed? Mesh for Laparoscopic Ventral Hernia Repair

Background and Objectives:

Laparoscopic technique to repair ventral hernia offers advantages over conventional open surgery such as shorter recovery time, decreased pain, and lower recurrence rates. There are a myriad of meshes available for laparoscopic repair of ventral hernias. This study evaluated the outcomes of laparoscopic repair of ventral hernias with Proceed mesh (Ethicon, Somerville, NJ, USA) in a single academic institution.

Methods:

An institutional review board–approved retrospective review was performed for 100 consecutive patients with ventral hernia who underwent a laparoscopic approach at our institution from August 2006 to February 2009. All patients were operated on by a single surgeon using a standard technique with transabdominal suture fixation and tacks.

Results:

The study included 100 consecutive patients (57 female and 43 male patients). The mean age was 55 years (range, 16–78 years), and the mean body mass index was 33.3 kg/m² (range, 19.6–68.9 kg/m²). Of the repairs, 27% were performed for a recurrent hernia. The mean and median size of the defect were 128 cm² and 119.5 cm² (range, 4–500 cm²), respectively. To ensure appropriate mesh overlap, the mean size of mesh was 253 cm² (range, 36–700 cm²). There were 4 conversions. The mean operative time was 117 minutes (range, 35–286 minutes). The mean length of stay was 1.9 days. There were no major abdominal complications. With a mean follow-up period of 50 months (range, 38–68 months), we have not recorded any recurrences. No mesh-related complications have been documented.

Conclusions:

The laparoscopic approach to ventral hernia repairs using Proceed mesh is associated with a low conversion rate and no major complications. At 50 months of follow-up, the recurrence rate is 0%. There were no mesh-related complications.     

Polypropylene Mesh加固胰肠吻合术的临床应用

我们在总结既往胰肠吻合方式的基础上,设计了Polypropylene Mesh加固胰肠吻合术,即将Mesh"腰带式"加固胰腺残端后与空肠端端连续单层缝合,旨在缩短手术时间,降低胰十二指肠切除后胰漏发生率.2005年8月至2006年12月,我们共行开腹状态下Mesh加固胰肠吻合术17例,现报道如下:     

Mesh removal after vaginal surgery: what happens in the UK?

Introduction and hypothesis

There is little objective evidence regarding complication rates for mesh procedures outside clinical trials. Current coding poorly collects complications of prolapse and continence surgery using mesh. This survey was designed to identify surgeons performing mesh removal and reporting patterns in the UK.

Methods

An electronic questionnaire was sent to all members of the Royal College of Obstetricians and Gynaecologists and members of the Section of Female Neurological and Urodynamic Urology of the British Association of Urologists in the UK. The questionnaire aimed to identify the number of procedures performed for mesh complications and whether they were reported to the Medicines and Healthcare products Regulatory Agency (MHRA) and the patterns of referral and treatment

Results

Referral to a colleague in the same hospital was common practice (69 %). Only 27 % of respondents stated that they reported all removals to the MHRA. The numbers of surgical procedures were low, with most respondents performing between one and three procedures each year and many not performing any surgery for a specific mesh complication in the previous year.

Conclusions

Removal of exposed, eroded and/or painful vaginally inserted mesh is performed by many different surgeons in a variety of hospital settings in the UK.

     

Bard Composix Mesh补片在腹壁巨大切口疝中的应用

切口疝是普外科手术常见的并发症之一。我科针对胃癌根治、胃溃疡胃大部切除术、胆囊切除、胆总管切开取石术、肝癌肝叶切除术等术后形成的28例巨大切口疝使用Composix Mesh补片进行疝修补术，取得了满意效果，现报告如下。     

应用GORE-TEX Dual Mesh行开放式造口旁疝修补术

目的评估应用GORE-TEX Dual Mesh行开放式造口旁疝修补的方法、安全性及临床效果。方法回顾性分析2003年1月至2008年1月在我科应用GORE-TEX Dual Mesh行开放式造口旁疝修补的50例患者的手术情况、术后并发症、住院时间和复发情况。结果50例患者顺利完成开腹造口旁疝修补术,平均手术时间80（60～100）min,平均术后住院7（5～9）d。发生伤口脂肪液化2例,浆液肿1例,经穿刺和理疗后治愈。无肠瘘、尿漏等并发症发生。随访12～48个月,无造口旁疝复发。结论使用GORE-TEX Dual Mesh行开放式造口旁疝修补是一种安全、有效的手术方法。     

Transvaginal Mesh for Prolapse Repair: What is All the Controversy About?

The use of synthetic mesh for the management of pelvic organ prolapse has been embroiled in a contentious debate over the past decade, with only more partisanship among physicians strictly against its use versus those pelvic surgeons who believe it to be a useful tool in their armamentarium. At the heart of the controversy lies the concern, by its detractors, for complications related to mesh use outweighing the as yet not rigorously tested benefit of augmenting repairs with mesh. This article discusses, in detail, the current literature supporting the use of mesh in the management of pelvic organ prolapse repair. The rising concern for complications, both simple and complex, will be addressed. This review aims to narrow the divide between physicians and to address their discordant beliefs by objectively reporting the most up-to-date data on biologic and synthetic mesh use in pelvic organ prolapse repair.     

Prophylactic Intraperitoneal Onlay Mesh Following Midline Laparotomy—Long-Term Results of a Randomized Controlled Trial

World Journal of Surgery - Incisional hernia, a serious complication after laparotomy, is associated with high morbidity and costs. This trial examines the value of prophylactic intraperitoneal...     

Intra Peritoneal Polypropylene Mesh and Newer Meshes in Ventral Hernia Repair: What EBM Says?

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.     

腹腔镜下Mesh网片阴道骶骨前固定治疗膀胱脱垂疗效及安全性分析

目的探讨腹腔镜下Mesh网片阴道骶骨前固定术(LSC)在治疗膀胱脱垂导致女性顽固下尿路症状(LUTS)中的临床疗效及安全性。方法 2013年3月至2014年6月深圳中山泌尿外科医院应用LSC治疗膀胱脱垂导致女性顽固LUTS患者10例,年龄46~77岁,病程4~12年,比较患者手术前后下尿路症状、性功能改善情况及尿流率、残余尿改善情况。通过Bristol女性下尿路症状问卷表(FLUTS-Q),分析LSC的疗效和安全性。结果 10例手术均顺利完成,手术时间(195±52)min;术中出血量(150±88)ml。9例患者尿频症状完全消失(90%),1例较术前明显改善;10例患者排尿困难症状均消失(100%);术前有尿急症状的患者中,3例症状改善(60%),无尿急症状的5例患者中,术后新发尿急症状2例(40%),术后2个月改善;术前有压力性尿失禁的4例患者中2例(50%)症状改善;6例术前无压力性尿失禁,术后新发1例(17%);手术前后最大尿流率、残余尿量和Bristol(FLUTS-Q)评分比较差异有统计学意义(P0.05)。结论 LSC可以有效改善女性膀胱脱垂导致的下尿路症状,微创、并发症少、安全有效。但对腹腔镜技术要求较高,学习曲线较长。     

Prophylactic Closure of Trocar Orifices with an Intraperitoneal Mesh (Ventralex®) in Laparoscopic Bariatric Surgery

Laparoscopic surgery reduces, but not eliminates, the rate of incisional hernia. It is accepted that large trocar orifices should be sutured, in order to prevent future herniation. In morbidly obese patients, the closure of the anterior fascia is a very difficult job, and it does not prevent from preperitoneal herniation. Ventralex composite mesh is a very easy-to-place device, which closes satisfactorily both the peritoneal opening and the subcutaneous trocar pathway. We recommend its use for large diameter orifices and Hasson orifices in bariatric patients.     

Does Prophylactic Biologic Mesh Placement Protect Against the Development of Incisional Hernia in High-risk Patients?

Background  

The purpose of this study was to determine whether the prophylactic use of a biologic prosthesis protects against the development of incisional hernia in a high-risk patient population.     

What is the Gold Standard for Posterior Vaginal Wall Prolapse Repair: Mesh or Native Tissue?

Reports in the literature of high recurrence rates after native tissue repair for pelvic organ prolapse led to the development of alternative techniques, such as those using synthetic mesh. Transvaginal mesh (TVM) delivery systems were implemented in search of better outcomes. Despite reported recurrence as low as 7.1 % after posterior colporrhaphy, mesh kits were developed to correct posterior compartment prolapse. There is a paucity of data to substantiate better results with TVM for rectocele repair. Three randomized controlled trials comparing native tissue repair to synthetic mesh reported posterior compartment outcomes and two of these failed to show a significant difference between groups. Complications of TVM placement are not insignificant and mesh extrusion was reported in up to 16.9 %. Based on currently available data, native tissue repairs have similar outcomes to synthetic mesh without the risks inherent in mesh use and remain the standard of care for the typical patient.     

Elective Inguinal Hernia Repair with Mesh: Is there a Need for Antibiotic Prophylaxis? — A Review

Although it is widely accepted that antibiotic prophylaxis is indicated in elective mesh repair of inguinal hernia, the evidence for its value has been controversial. A recent Cochrane meta-analysis showed that there is insufficient data overall to demonstrate a clear advantage of prophylaxis and illustrated the classic problem in evidence-based medicine where a lack of evidence in support of an intervention may be interpreted as a reason not to implement it. This review of the literature evaluates the evidence for the effectiveness of intravenous antibiotics as prophylaxis in inguinal hernia repair with mesh. Pubmed and Embase searches revealed seven trials of antibiotic prophylaxis in mesh repair of inguinal hernia. The quality of the evidence and the limitations of the seven trials are discussed. Analysis of these seven trials adds to the Cochrane meta-analysis of Sanchez-Manuel and Seco-Gil. Only two of the trials support the use of antibiotic prophylaxis, and those were the only double-blind randomized controlled trials reviewed. In evidence-based medicine the absence of evidence in clear support of an intervention (as in this review, where only two of the seven trials support the use of antibiotic prophylaxis) may be taken as reason not to implement the intervention. It is possible, however, that what is needed to clarify the issue are further randomized controlled trials, rigorously performed and recruiting significantly larger numbers of patients. This review was prepared as part of the MSc in Surgical Practice programme developed by the Kent Institute of Medicine and Health Sciences, University of Kent