补片修补切口疝23例分析

目的：探讨补片修补腹壁切口疝的方法及疗效。方法：采用聚丙烯或聚丙烯与聚四氟乙烯双面材料网片修补腹壁切口疝23例，网片采用双圈间断缝合固定术式，外圈网片固定部位距缺损边缘4cm以上。结果：术后23例患者随访4～36个月无1例复发。结论：补片修补切口疝安全，可靠，复发率低。     

聚丙烯网片修补腹部巨大切口疝65例分析

目的：探讨聚丙烯网片修补腹壁巨大切口疝的手术方法和临床效果。方法：用聚丙烯网片修补65例腹壁巨大切口疝的临床资料。结果：全组患者均手术修复成功,无皮下积液、切口感染及排异反应等并发症。随访1～6 a无一例复发。结论：腹壁切口疝聚丙烯网片修补术是一种无张力修补术。其并发症少、术后恢复快、复发率低,明显优于其他手术方法,可作为腹壁巨大切口疝修补的首选方法。     

Ⅱ、Ⅲ类切口置聚丙烯网片治疗腹外疝7例

目的 评价在带有污染的Ⅱ、Ⅲ类切口中置入聚丙烯网片对腹外疝进行无张力疝修补术的临床效果。方法 回顾性总结7例腹外疝病人的临床资料，其中4例为嵌顿性腹股沟疝术中发现小肠坏死，作小肠部分切除，再用聚丙烯网片作无张力疝修补术。1例为三次消化系统手术后发生二处横结肠瘘合并切口疝，再手术切除部分横结肠，切口以聚丙烯网片作切口疝修补术。1例切口疝术中结肠割破及1例腹股沟疝切口上方2cm有结肠造瘘口，均以聚丙烯网片作疝修补术。7例病人切口内均放置引流物，术前、术后均全身应用抗生素3～5天。结论 7例病人切口均一期愈合，未发生感染，随访5～29个月，均未有疝复发。结果 聚丙烯网片组织相容性好，无明显排异反应，抗感染力强，只要术前、术中、术后处理得当，即使网片安置在Ⅱ、Ⅲ类切口中也不易发生感染。在带有污染的切口内应用聚丙烯疝修补材料治疗腹外疝是可行的，且临床效果满意。     

聚丙烯网片修补腹壁巨大切口疝的围手术期护理

目的为避免聚丙烯网片修补腹壁巨大切口疝术后复发,减少术后并发症,促进早日康复,总结护理经验。方法总结16例采用聚丙烯网片无张力修补腹部巨大切口疝病人的护理经验,并随访观察长期疗效。结果随访术后1-5年,术后5年无复发的13例,术后2年内局部复发的1例。余2例术后才1年无复发。结论完整及时的围手术期护理是使用聚丙烯网片行无张力腹壁巨大切口疝修补术成功的重要保证。     

人工补片材料修补腹壁巨大切口疝:同一机构5年13例资料回顾

背景:腹部巨大切口疝是腹部术后治疗难题,近年来用聚丙烯和聚四丙烯复合切口疝补片修腹壁巨大切口疝已成为主要方法,临床已有很多成功和失败的范例.目的:评价应用人工补片材料修补腹壁巨大切口疝5年13例资料的特点和应用安全性.方法:于2000-01/2005-06收治术后巨大腹壁切口疝患者13例,男9例,女4例,平均年龄61岁.均为初次切口疝,疝环最大径为20 cm,平均16.1 cm.术前治疗合并症,沿原手术切口逐层切开皮肤及皮下组织,游离和松解疝囊周边黏连,显露疝环.游离完毕,回纳疝囊,将适当大小人工补片材料平铺在腹横筋膜与腹直肌后鞘之间,游离腹直肌前鞘腹侧至疝环外3 cm,将网片边缘问断缝合固定于前方的肌筋膜层以方便缝合固定补片.术后严密监测患者循环和呼吸功能变化.结果与结论:13例患者术后均恢复顺利,无严重并发症.有3例发生皮下积液,经穿刺抽吸,局部压迫等处理后完全吸收,全组患者随访1-3年,无复发.提示人造补片材料修复腹壁巨大切口疝安全有效.     

巨大腹壁切口疝30例治疗体会

目的:探讨巨大腹壁切口疝的围手术期处理经验和手术治疗方法.方法:对2000年1月至2007年12月30例巨大腹壁切口疝患者的诊治经过进行回顾性分析.结果:30例患者均采用人工材料修补.其中23例采用单层聚丙烯网片修补.7例采用Composix复合补片修补.全组无围手术期死亡,无切口感染,平均随访时间为42个月,无复发病例,6例(20.0%)患者术后早期有轻度腹壁不适.结论:加强围手术期处理和掌握正确的人工材料修补方法是治疗巨大腹壁切口疝的关键.     

应用聚丙烯编织网修补36例腹壁巨大切口疝

目的：探讨腹壁巨大切口疝术方法。方法：对36例腹壁巨大切口疝采用聚丙烯编织网进行无张力修补。结果：36例患者手术顺利，无手术并发症，术后无疼痛感，随访8～30个月无复发。结论：应用聚丙烯编织网无张力性修补腹壁巨大切口疝符合生理的手术方法，具有无张力，复发率低等特点。     

聚丙烯网片在疝修补术中的临床应用

目的 总结应用聚丙烯网片修补腹股沟疝的治疗效果。方法 应用聚丙烯网片修补65例腹股沟疝患者，观察手术效果，术后恢复及并发症和复发率情况。结果 聚丙烯网片无张力疝修补术，与传统的疝修补术相比，手术时间短，术后恢复快，并发症少，复发率低。结论 应用聚丙烯网片修补腹股沟疝较为理想，值得推广应用。     

腹腔镜腹壁切口疝修补术的应用分析

目的 探讨腹腔镜腹壁切口疝防粘连网片修补的手术方法及临床效果.方法 回顾性分析2006年5月～2009年3月完成的10例腹腔镜下腹壁切口疝防粘连网片修补术的临床资料.结果 10例手术均获成功.无中转开腹.手术时间45～125 min,平均83.5 min.术中出血30～120 mL,平均52 mL.10例术后均恢复顺利,术前症状完全缓解.术后住院时间3～13d,平均6.5 d.术后随访12 ～ 40个月,未发现复发病例.结论 应用防粘连网片行腹腔镜腹壁切口疝修补术具有手术时间短、修复可靠、创伤小、恢复快等特点,是治疗腹壁切口疝的一种较为理想的手术方法.     

聚丙烯网片用于腹部大切口疝修补的护理

总结53例应用聚丙烯网片行腹部大切口疝修补术的护理。认为护理重点是术前做好腹内压的适应性训练,完善各项术前准备;术后严密监测患者的生命体征,保持腹壁引流管通畅及有效引流,加强疼痛护理及营养支持,重视出院指导。53例痊愈出院,术后随访3～23月,除6例失访外,无再次复发病例。     

腹股沟疝无张力修补术后复发的临床分析

【目的】探讨无张力腹股沟疝修补术后复发的原因、治疗及预防。【方法】对4年来因腹股沟疝无张力修补术后复发的15例患者的资料进行回顾性分析其原因,探讨预防的方法及对复发疝的治疗。【结果】15例患者,复发原因为无张力修补术后疝内环口与充填之网塞间隙过大2例;充填之网塞未能固定在疝环口周围的致密坚韧组织上复发3例;网塞缝合固定,但网片未固定3例;因网片过小复发2例;网片卷曲移位3例;网片精索孔过大2例。【结论】无张力腹股沟疝修补术后复发疝的原因主要是术中对网片和网塞的置入和固定不当所致,治疗仍采取无张力腹股沟疝修补术。     

腹股沟马鞍疝无张力疝修补手术方式的选择

目的：探讨腹股沟马鞍疝无张力疝修补手术方式的选择。方法：回顾性调查206例腹股沟马鞍疝患者,其中行巴德网塞充填式修补术57例,普里灵疝装置腹膜前间隙修补术149例,观察两种修补方式的手术时间、手术方式及要点、术后并发症、恢复情况、平均住院日及复发率。结果：两种方式修补的患者围手术期均无死亡。手术时间、恢复情况、术后平均住院天数和并发症两种方式差异均无统计学意义（P〉0．05）。患者术后平均随访分别为（2．3±0．5）和（2．2±0．7）年,随访时间无统计学差异（P〉0．05）。普里灵疝装置修补组的费用较巴德网塞组低。57例巴德网塞修补术后有2例复发,149例普里灵疝装置腹膜前间隙修补术后无复发。结论：腹膜前间隙无张力疝修补术是腹股沟马鞍疝的首选手术方式。     

Comparison between anatomical polyester (Parietex) mesh and polypropylene (Prolene) mesh with fixation in total extraperitoneal repair for inguinal hernia

Introduction: Laparoscopic inguinal hernia surgery has been gaining in worldwide popularity, with the total extraperitoneal (TEP) repair gaining greater acceptance than the transabdominal pre‐peritoneal repair. Most techniques using TEP advocate some form of fixation of the prosthesis, but newer meshes avoid the use of fixation. Methods: We compared the use of the polyester mesh (Parietex; Tyco, Princeton, USA) without fixation and polypropylene (Prolene; Ethicon, USA) mesh with fixation using either ProTack (Tyco, USA) or EndoAnchor (Ethicon, Cincinnati, USA) in a consecutive series of patients who underwent total TEP endoscopic inguinal hernia repair. Results: Of 127 patients who underwent TEP repairs, 60 had Parietex mesh while 67 had Prolene mesh with fixation. The mean age was 50 years old and 97% were men. There was no difference in patient demographics or complication rate. The most common complication was small seroma or hematoma formation in 14% of patients and none required re‐operation. There was no hernia recurrence in either group with a mean follow‐up period of 13 months. Conclusion: This study shows that in laparoscopic TEP inguinal hernia repair, early results indicate comparable results between the use of polyester (Parietex) mesh without fixation and polypropylene (Prolene) mesh with fixation.     

Value of CT after laparoscopic repair of postsurgical ventral hernia

BACKGROUND: We examined computed tomographic (CT) findings after laparoscopic repair of postsurgical ventral hernias in patients with and without symptoms. METHODS: Meshes were placed laparoscopically in 18 patients for incisional ventral hernia repair. CT of the abdominal wall was performed 1, 15, and 30 days after repair and when clinical findings indicated the procedure. RESULTS: Scans of four patients showed small fluid collections within the abdominal wall between the hernia sac and the mesh. These collections resolved within the first 30 days without aspiration. Scans of three patients with symptoms 4-8 months later showed fluid collections that required multiple aspirations in one patient and a recurrent hernia that was repaired laparoscopically in another patient. CONCLUSION: Preliminary results suggest that CT is a useful imaging tool in patients with laparoscopic repair of incisional vetral hernia. It showed the correct site of the mesh, subclinical fluid collections in the abdominal wall, and recurrent hernia.     

腹腔镜腹壁切口疝补片修补临床分析

目的 探讨穿刺针及钩针在腹腔镜腹壁切口疝补片修补中的应用.方法 2006年1月至2008年12月我院应用穿刺针及钩针为23例腹壁切口疝患者行腹腔镜腹壁切口疝补片修补.结果 23例手术均顺利完成,用时60.0～210.0 min,平均(120.0±5.7)min;术后15.0～42.0 h,平均(28.0±2.3)h排气;2～3 d进食,住院5.0～10.0 d,平均(7.0±0.8)d.术后疼痛3个月以上5例,浆液肿4例,对症治疗后好转,随访10～36个月无疝复发.结论 应用穿刺针及钩针固定补片,方法简单,容易操作,可完成腹腔镜腹壁切口疝补片修补,值得在基层医院推广.     

肾移植术后切口疝的临床诊治

目的探讨肾移植术后切口疝的治疗。方法对收治的5例肾移植术后切口疝（3例外院,2例本院）患者均采用聚丙烯疝补片无张力修补手术治疗。结果 5例患者手术均顺利,手术平均时间为（1.5±0.3）h,住院平均时间8 d,均痊愈出院。术后随访1年均未复发,且对移植肾功能无明显影响。结论肾移植术后切口疝的诱发因素较多,治疗以疝补片无张力修补术为佳。     

Laparoscopic intraperitoneal mesh repair of a large incisional hernia in a kidney transplantation patient: A case report

A 73-year-old woman presented to our hospital because of painful bulging in the right lower abdomen, and developed a 17 × 12 cm incisional hernia after kidney transplantation using right oblique incision. Laparoscopic intraperitoneal onlay mesh (IPOM) repair was performed. Since a transplanted kidney is close to the abdominal wall defect, the space between the transplanted kidney and the abdominal wall was peeled off to secure enough space for the mesh to be place. After that the fascial defect was detected precisely, and the polypropylene-polyglycolic acid composite mesh was fixed with 3 cm overlapping of the hernia ring by non-absorbable tacks. The patient was discharged 9 days after surgery. In general, abdominal incisional hernias after kidney transplantation are relatively large with boundary defect of abdominal wall ensuing between the abdominal and allograft. However, laparoscopic IPOM repair of incisional hernia after kidney transplantation can be performed safely and effectively.     

Lightweight polypropylene mesh fixation in laparoscopic incisional hernia repair

Abstract

Introduction: The choice of the mesh and fixation methods in laparoscopic incisional hernia repair is a crucial issue in preventing complications and recurrence. The authors report a series of 40 consecutive laparoscopic incisional hernia repairs, focusing on the use of lightweight polypropylene mesh and on the way of mesh fixation. Material and methods: Forty laparoscopic incisional hernia repairs performed consecutively in 38 patients (16 males, 22 females) were retrospectively evaluated. Patients were divided into two groups depending on tacks used: Titanium tacks vs absorbable tacks. Results: All patients received totally laparoscopic incisional hernia repair by the use of lightweight polypropylene mesh. No major post-operative complications were reported. Post-operative pain (evaluated by VNS) was higher in Group A (titanium tacks, p < 0.05). No differences in follow-up as well as in recurrence incidence (one case in both groups, <6 months time interval) were reported. Conclusions: Securestrap? absorbable tacks are safe and effective and easy to use and did not increase the risk of mesh dislocation compared with non-absorbable tacks. The specific design well fits the lightweight polypropylene mesh Physiomesh?. Further evaluations in larger randomized studies are needed to confirm these preliminary data.     

The first case of robotic-assisted transabdominal retrorectus repair for incisional hernia in Japan

Extraperitoneal mesh repair for ventral hernia has garnered attention and its rate has been increasing due to concerns for the potential complications of intraperitoneal mesh repair. Recently, robotic-assisted ventral hernia repair is highlighted as a solution to the technically demanding nature of laparoscopic transabdominal or enhanced-view totally extraperitoneal retrorectus ventral hernia repair. A 78-year-old man, who had undergone robot-assisted radical prostatectomy 10 months earlier, presented with an incisional hernia of European Hernia Society Classification M3W2, length 4 cm, width 5 cm with rectus diastasis. A right single-docking robotic-assisted transabdominal retrorectus repair was performed using a 21 by 14 cm self-gripping mesh and anterior wall reconstruction was done by 0 barbed nonabsorbable running suture. There were no complications and recurrence observed during a 7 months postoperative period. Single-docking robotic-assisted transabdominal retrorectus repair was considered a good option for midline moderate-size incisional hernias from the point of view of the ease of suturing, adequateness of dissection and prevention of bowel injury.