腹腔镜下腹壁切口疝补片修补术的初步经验

目的:探讨腹腔镜下腹壁切口疝修补术的手术方法、安全性等问题。方法:对我院2004年3月～11月间收治的25例腹壁切口疝病人,进行腹腔镜下修补术。结果:24例(96%)手术成功,1例(4%)因腹腔内广泛粘连而中转为剖腹修补。平均手术时间为110min,平均术后住院6d,6例(24%)病人术中发现有一个以上的隐匿性缺损。术后并发症有:术后短期内修补区腹壁明显疼痛21例(84%),腹壁缝合点较长时间疼痛6例(24%),浆液肿3例(12%);无修补区感染,也未发现早期复发的病例。结论:对腹壁切口疝,多数病人是可以经腹腔镜进行粘连松解及补片修补术的,还可在术中发现其他隐性缺损。对腹腔内广泛粘连而影响操作器械的进入及分离者,应及时中转剖腹手术。

Laparoscopic approach to mesh repair of abdominal incisional hernias

Objective To analyze the experience in laparoscopic approach to mesh repair of abdominal incisional hernias. Methods Mesh repair was performed laparoscopically in 25 patients with abdominal incisional hernias from Mar. to Nov. 2004. Results The operation was successfully performed in 24 patients(96%) and 1 case (4%) was converted to an open procedure because of extensive intra-abdominal adhesion. The mean operating time was 110 min and the mean hospital stay was 6 days. Six patients(24%) were found to present more than one hernial defect unexpectedly. Postoperative complications included temporary severe pain in the operative area(n=21, 84%), prolonged pain in the suture site (n=6, 24%), and seroma (n=3, 12%); no wound infection, nor early recurrence occurred in our cases. Conclusions Laparoscopic mesh herniorrhaphy could be performed in most incisional hernia cases after complete dissection of adhesion. Through laparoscopy, other unexpected defects could be discovered. Postoperative pain in the operative area could be severe. Should extensive dense adhesions interfere with the manipulation, conversion to open operation might be preferable.