Mesh versus direct suture for the repair of umbilical and epigastric hernias. Ten-year experience.
Mesh versus direct suture for the repair of umbilical and epigastric hernias. Ten-year experience.
复制标题
网状与直接缝合修复脐疝和上腹疝。
DOI：
--
复制
发表时间：
2009
影响因子：
0.8
通讯作者：
E. Gianetta
中科院分区：
文献类型：
--
作者：
C. Stabilini;M. Stella;M. Frascio;L. De Salvo;R. Fornaro;G. Larghero;F. Mandolfino;F. Lazzara;E. Gianetta
背景
本研究的目的是评价补片与一期缝合手术用于修补前腹壁中线疝的结局。
结果
1995年至2005年，98例患者（46例男性）接受了脐疝（69例）或上腹疝（29例）修补术。第1组34例，一期缝合缺损。在64例病例中放置聚丙烯补片（第2组）。总体而言，平均腱膜缺损直径为2.5 cm（范围0.5 +/- 10 cm）。76例手术在局部麻醉下进行（第1组71%，第2组81%）。第2组发生的并发症包括3例血清肿、1例血肿和1例假体感染。计划每年随访一次，直至术后第5年。第1组的复发率为14.7%，第2组为3.1%（对数秩检验p 0.0475）。
结论
局麻下腹壁中线疝的前腹膜前补片修补术似乎是一种安全有效的技术，可作为日间手术进行。与缝线修复相比，补片修复术后局部并发症风险略微增加，但复发率降低抵消了这一风险。
BACKGROUND
The objective of this study was to evaluate outcomes of mesh versus primary suture procedures for repair of anterior abdominal wall midline hernias.
RESULTS
Between 1995 and 2005, 98 patients (46 males) underwent repair of umbilical (69 cases) or epigastric (29 cases) hernias. Primary suture of the defect was performed in 34 cases (group 1). A polypropylene mesh was positioned in 64 cases (group 2). Overall, mean aponeurotic defect diameter was 2.5 cm (range 0.5 +/- 10 cm). Procedures were carried out under local anesthesia in 76 instances (71% group 1 vs. 81% group 2). Complications occurring in group 2 comprised three seromas, one hematoma and one prosthetic infection. Follow up was scheduled yearly up to the fifth postoperative year. Recurrence rate in group 1 was 14.7% compared to 3.1% in group 2 (logrank test p 0.0475).
CONCLUSIONS
Anterior preperitoneal mesh repair of abdominal wall midline hernias under local anesthesia seems to be a safe and effective technique that can be performed as a day surgery procedure. A slightly increased risk of postoperative local complications following mesh repair is offset by a reduced rate of recurrence in comparison to suture repair.