Repair of large midline incisional hernias with polypropylene mesh: Comparison of three operative techniques
Tóm tắt
Polypropylene mesh is widely used for the reconstruction of incisional hernias that cannot be closed primarily. Several techniques have been advocated to implant the mesh. The objective of this study was to evaluate, retrospectively, early and late results of three different techniques, onlay, inlay, and underlay. The records of 53 consecutive patients with a large midline incisional hernia — 25 women and 28 men, mean age 60.4 (range 28–94) — were reviewed. Polypropylene mesh was implanted using the onlay technique in 13 patients, inlay in 23 patients, and underlay in 17 patients. Either the greater omentum or a polyglactin mesh was interponated between the mesh and the viscera. The records of these 53 patients were reviewed with respect to: size and cause of the hernia, pre- and postoperative mortality and morbidity, with special attention to wound complications. Patients were invited to attend the outpatient clinic at least 12 months after implantation of the mesh for physical examination of the abdominal wall. Postoperative complications occurred in 14 (26.4%) patients. The onlay technique had significantly more complications, as compared to both other techniques. Reherniation occurred in 15 (28.3%) patients. The reherniation rate of the inlay technique was significantly higher than after the underlay technique (44% vs 12%, P=0.03) and tended to be higher than the onlay technique (44% vs 23%, P=0.22). Repair of large midline incisional hernias with the use of a polypropylene mesh carries a high risk of complications and has a high reherniation rate. The underlay technique seems to be the better technique.
Tài liệu tham khảo
George CD, Ellis H (1986) The results of incisional hernia repair: a twelve-year review. Ann R Coll Surg Engl 68:185–7
Luijendijk RW, Hop WCJ, van den Tol MP, de Lange DCD, Braaksma MMJ, IJzermans JNM, Boelhouwer RU, de Vries BC, Salu MKM, Wereldsma JCJ, Bruijninckx CMA, Jeekel J (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med 343:392–8
Usher FC, Ochsner J, Tuttle LLD (1958) Use of Marlex mesh in repair of incisional hernias. Am Surg 24:969–74
Simmermacher RK, Schakenraad JM, Bleichrodt RP (1994) Reherniation after repair of the abdominal wall with expanded polytetrafluoroethylene. J Am Coll Surg 178:613–6
Larson GM, Harrower HW (1978) Plastic mesh repair of incisional hernias. Am J Surg 135:559–63
Lewis RT (1984) Knitted polypropylene (Marlex) mesh in the repair of incisional hernias. Can J Surg Mar; 27(2):155–7
Liakakos T, Karanikas I, Panagiotidis H, Dendrinos S (1994) Use of Marlex mesh in the repair of recurrent incisional hernia. Br J Surg 81:248–9
Molloy RG, Moran KT, Waldron RP, Brady MP, Kirwan WO (1991) Massive incisional hernia: abdominal wall replacement with Marlex mesh. Br J Surg 78:242–4
Wagman LD; Barnhart GR, Sugerman HJ (1985) Recurrent midline hernia repair. Surg Gynecol Obstet 161:181–2
Stoppa RE (1989) The treatment of complicated groin and incisional hernias. World J Surg 13:545–54
Schumpelick V, Conze J, Klinge U (1996) Preperitoneal mesh-plasty in incisional hernia repair. A comparative retrospective study of 272 operated incisional hernias. Chirurg 67:1028–35
Schumpelick V, Klosterhalfen B, Muller M, Klinge U (1999) Minimized polypropylene mesh for preperitoneal net plasty (PNP) of incisional hernias. Chirurg 70:422–30
Temudom T, Siadati M, Sarr MG (1996) Repair of complex giant or recurrent ventral hernias by using tension-free intraparietal prosthetic mesh (Stoppa technique): lessons learned from our initial experience (fifty patients). Surgery 120:738–43
Trupka AW, Hallfeldt KK, Schmidbauer S, Schweiberer L (1998) Management of complicated incisional hernias with underlay-technique implanted polypropylene mesh. An effective technique in French hernia surgery. Chirurg 69:766–72
Duce AM, Muguerza JM, Villeta R, Martin J, Gutierrez A, Diez M, Noguerales F, Granell J (1997) The Rives operation for the repair of incisional hernias. Hernia 1:175–177
Duce AM, Noguerales F, Villeta R, Hernandez P, Lozano O, Keller J, Granell J (2001) Modifications to Rives technique for midline incisional hernia repair. Hernia 5:70–72
de Vries Reilingh TS, van Goor H, Rosman C, Bemelmans MHA, de Jong D, van Nieuwenhoven EJ, van Engeland MIA, Bleichrodt RP (2003) Components separation technique for the repair of large abdominal wall hernias. J Am Coll Surg 196:32–37
Sackett DL, Straus SE, Richardson WS, Rosenberg W, Haynes RB (1997) Evidence-based medicine, How to practice and teach EBM. Churchill Livingstone