Laparoscopic Evaluation Shows Deficiencies in Memory Ring Deployment During Small Ventral Hernia Repair
Laparoscopic Evaluation Shows Deficiencies in Memory Ring Deployment During Small Ventral Hernia Repair
复制标题
腹腔镜评估显示小腹疝修复过程中记忆环部署的缺陷
DOI：
10.1007/s00268-011-1182-8
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发表时间：
2011
影响因子：
2.6
通讯作者：
C. Berney
中科院分区：
文献类型：
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作者：
C. Berney
我祝贺Frederik Berrevoet及其合作者最近在《世界外科杂志》上发表的文章。28例患者采用自膨胀、含记忆的增强聚丙烯/膨胀聚四氟乙烯（ePTFE）补片修复腹侧小疝，并通过同步腹腔镜评估客观评估。结果非常令人失望，大多数病例在腹腔镜下疝补片定位不到位，中位随访25个月后复发率为14.8%。我想提出几点意见。基于开放式衬底技术的小脐疝和腹疝修复已经变得非常流行，因为它快速且易于操作，提供了将假体放置在腹壁后的好处，同时避免了不必要的，更具侵入性和昂贵的腹腔镜方法。不幸的是，它的缺点是有发生腹腔内网相关并发症的潜在风险，如形成致密粘连或网糜烂进入小肠。其中一名患者术后仅两周就发生了这种情况，因此很可能与技术错误有关。我认为疝补片的大小是这种方法的主要限制。贴片越大，当定位带被拉起固定时，网片“拔罐”的风险就越高。这种拔罐增加了聚丙烯网面暴露。在他们的研究中，Berrevoet等人在86%的病例中使用大疝补片（直径8厘米），其余手术使用中等大小的补片（6.4厘米）。相比之下，在过去的4年里，我对66名患者使用了相同的假体，但只有15%的病例使用了大尺寸的网状物（未发表的数据）。虽然这些疝气修复不是腹腔镜控制的，但在20个月的中位随访中，我没有遇到任何复发或主要并发症。最近的一项研究，同样使用了更小尺寸的疝修补片，也显示了类似的结果。然而，根据Berrevoet等人的研究结果，最后，我建议将补片放置在肌后或腹膜前间隙，而不是腹膜内。如果这种放置不可行，我的下一个建议是避免使用大尺寸的假体贴片，除非有可能将其边缘安全地固定在腹壁上，从而避免上述拔罐效应。
To the Editor I congratulate Frederik Berrevoet and collaborators for their recent publication in World Journal of Surgery [1]. The repair of small ventral hernias in 28 patients was performed with a self-expanding, memory-containing reinforcement polypropylene/expanded polytetrafluoroethylene (ePTFE) patch and objectively assessed by simultaneous laparoscopic evaluation. The results were very disappointing, showing inadequate positioning of the hernia patch at laparoscopy in the majority of the cases and a 14.8% recurrence rate after a median follow-up of 25 months. There are few points that I would like to raise. Repair of small umbilical and ventral hernias based on the open underlay technique has become very popular as it is quick and easy to perform, offering the benefits of having the prosthesis placed behind the abdominal wall, while at the same time avoiding an unnecessary, more invasive, and costly laparoscopic approach. Unfortunately, the downside is the potential risk of developing intraperitoneal meshrelated complications, such as formation of dense adhesions or mesh erosion into the small bowel. This happened in one of their patient only two weeks postoperatively, and therefore was most likely related to a technical error. I believe that the size of the hernia patch is the main limitation in this approach. The larger the patch, the higher the risk of getting ‘‘cupping’’of the mesh as the positioning straps are pulled up for fixation. Such cupping increases the exposure of the polypropylene side of the mesh.In their study, Berrevoet et al. used a large hernia patch (8 cm in diameter) in 86% of their cases and a mediumsized patch (6.4 cm) for the remaining procedures. In comparison, over the last 4 years I have used the identical prosthesis on 66 patients, but a large size mesh in only 15% of the cases (unpublished data). Although these hernia repairs were not controlled laparoscopically, I did not encounter any recurrence or major complication at a median follow-up of 20 months. A recent study, also using smaller size hernia patches, showed similar results [2]. Nevertheless, in light of the findings of Berrevoet et al., and to conclude, I recommend placing the mesh in the retromuscular or preperitoneal space rather than intraperitoneally. Should that placement not be practicable, my next suggestion would be to avoid using the large size prosthetic patch, unless it is possible to secure its edge safely to the abdominal wall, thus avoiding the above-described cupping effect.