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Curative effect analysis of three mesh positions for treatment of ventral hernia

ObjectiveTo study the clinical efficacy of three mesh positions for treatment of ventral hernia.MethodsThe data of 87 patients undergoing abdominal incision hernia repair from January 2015 to January 2017 in the First Affiliated Hospital of Zhengzhou University were analyzed respectively. They were divided into three groups according to the different mesh position, Onlay treatment (n=28), Inlay treatment (n=27) and Sublay treatment (n=32). The curative effect and complications of three different surgical methods were compared and analyzed.ResultsAll the patients were recovered and discharged. A total of 6 cases among 87 patients had incision fat liquefaction, 1 patient had superficial infection and 2 patients had postoperative incision hematoma. After 3 to 36 months of follow-up (average 8 months), 3 cases of 87 patients recurred.ConclusionsThree kinds of surgeries for ventral hernia are feasibility and value, Sublay treatment is not only less pain and complications but more effective. We should strengthen the screening of preoperative cases and selecting appropriate surgical methods to prevent and reduce the recurrence of hernia.

Surgical Treatment for Mesh Infection after Prosthetic Patch Repair of Ventral Hernia

ObjectiveTo summarize the method and experience in surgical treatment for mesh infection after prosthetic patch repair of ventral hernia. MethodsThe clinical data of 16 patients with mesh infection after ventral hernia repair accepted surgical treatment in our department from June 2007 to May 2010 were analyzed retrospectively. There were 10 males and 6 females, the age range from 24 to 73 years with an average 45.2 years. The patients with mesh infection included 11 cases of infection after incisional hernia repair, 4 cases of infection after abdominal wall defects repair caused by abdominal wall tumor resection, 1 mesh infection combine with urinary fistula caused by parastomal hernia of ileal neobladder repaired by using prosthetic patch. Clinical manifestation included mesh exposion, abscess, chronic sinus, and enterocutaneous fistula. All patients accepted local treatment of change dressing by primary operative surgeon, but the wounds didn’t heal about 3 to 24 months. Then the patients performed radical removal of infected mesh and abdominal wall reconstruction. ResultsAll patients accepted affected mesh removal successfully. Five patients performed abdominal wall reconstruction by using components separation technique. Four cases accepted abdominal wall repair by using polypropylene mesh. Five patients performed abdominal wall repair by using human acelluar dermal matrix. One case accepted change dressing and vacuum aspiration on the infected wound surface without reconstruction. And one case closed the wound immediately after infected mesh removal. The postoperative hospitalization time was 9 to 25 d (average 14 d). Thirteen patients recovered with primary wound healing. The other 3 cases recovered with second healing by local change dressing. All patients were followed up from 6 to 34 months (average 22 months), no abdominal wall hernia recurrence occurred. ConclusionsIt is very difficult to deal with mesh infection after prosthetic patch repair of abdominal wall hernia or defect. The surgical treatment should be done according to specific condition of each individual so as to acquire satisfied results.

Evaluation of Hernias of Abdominal Wall with Multislice CT

目的:探討螺旋CT對腹壁疝的診斷價值和臨床意義。方法: 收集被手術證實的腹壁疝86例,術前均進行螺旋CT檢查。觀察腹壁疝的部位、數目、疝囊大小、疝內容物及并發癥。結果: 86例腹壁疝中,腹股溝斜疝38例(雙側7例),腹股溝直疝8例,腹壁切口疝19例,造瘺口疝6例,閉孔疝3例,臍疝8例,白線疝2例,雙側腹股溝斜疝伴右下腹壁切口疝1例,雙測腹股溝斜疝伴左下腹壁造瘺口疝1例。疝囊直徑在5cm以下者45例, 6~10cm者38例, 10cm以上者3例,腹壁疝伴小腸不全梗阻者21例,切口疝伴感染1例。螺旋CT可以顯示腹壁疝的種類、數目、疝囊大小、疝內容物類型及存在的并發癥.結論: 螺旋CT是腹壁疝的一種非常有效的檢查方法,可以為外科綜合評價患者病情及進行有效手術治療提供重要依據。

Need to Pay Attention to Problems in Laparoscopic Repair of Recurrent Ventral Hernia

局部麻醉在腹壁疝修補術中的應用

目的總結局部麻醉下行腹壁疝修補術的臨床效果。 方法回顧性分析2010年7月至2014年6月期間我科收治的1 126例腹壁疝患者的臨床資料。 結果1 126例患者均于局部麻醉下行無張力疝修補術，其中腹股溝疝例1 088例，股疝21例，臍疝8例，切口疝4例，白線疝3例，戳孔疝2例。有3例患者改為全身麻醉。手術時間18～145 min，（63±12.4）min；術后住院時間1～6 d，（3.2±1.3）d；麻醉及術中監護費用（236.6±31.2）元。術后發生陰囊水腫積液3例，切口部位疼痛4例，無尿潴留、補片感染、腸瘺等發生。術后隨訪5～26個月，（19±4.8）個月，有2例腹股溝疝復發。 結論局部麻醉下行腹壁疝修補術可行及安全，術后恢復快，并發癥少，費用低。

Risk and benefit evaluations of biological versus synthetic mesh for ventral hernia repair: a meta-analysis

ObjectiveTo systematically evaluate the effects of biological mesh (BM) and non-absorbable synthetic mesh (SM) on the risks of recurrence, complications, and cost-effectiveness after ventral hernia repair. MethodsThe publicly published related researches of BM versus SM for ventral hernia repair were searched in the PubMed, Cochrane Library, Embase, Web of Science, CNKI, Wanfang, VIP, CBM databases from the establishment of the databases to August 1, 2021. According to the inclusion and exclusion criteria, the literatures were screened and the data were extracted, and the data that met the conditions were merged and analyzed. The meta-analysis was performed by RevMan5.4.1 software. ResultsA total of 26 studies with 3 259 patients were included, including 1 388 patients in the BM group and 1 871 in the SM group. The results of meta-analysis showed that the recurrence, surgical site infection, surgical site occurrence, reoperation rates, and medical costs in the BM group were higher than those in the SM group (P<0.05). There were no significant differences in the patch infection, seroma, hematoma, wound dehiscence, and readmission rates between the two groups (P>0.05). ConclusionsSM during ventral hernia repair is better than BM on postoperative recurrence, surgical site infection, surgical site occurrence, reoperation, etc., and could reduce medical costs. In the future, it is tried to use more SM in patients with complicated ventral hernia such as cleaning pollution and contaminated environment.