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首页> 外文期刊>Surgical Endoscopy >Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair.
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Prospective evaluation of adhesion characteristics to intraperitoneal mesh and adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair.

机译：事先评估腹腔镜疝修补后腹腔镜再探查期间对腹膜内网的粘附特性和与粘膜溶解相关的并发症的前瞻性评估。

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BACKGROUND: The purpose of this study was to characterize the adhesion characteristics of absorbable- and nonabsorbable-barrier-coated meshes and to report adhesiolysis-related complications during laparoscopic re-exploration after prior ventral hernia repair. METHODS: Under an IRB-approved protocol, patients undergoing laparoscopic re-exploration after prior intraperitoneal mesh placement were prospectively graded intraoperatively for adhesion tenacity (0-4), adhesion surface area (0 = 0%, 10 = 100%), and ratio of adhesiolysis time to mesh surface area (min/cm(2)). Adhesiolysis-related complications were also recorded. Data are given as mean +/- SD. Statistical significance (P < 0.05) was determined using the t test and Fisher's exact test. RESULTS: From March 2006 to March 2009, 69 patients underwent laparoscopic surgery after prior intraperitoneal mesh placement for ventral hernia repair. Previous meshes were absorbable-barrier-coated mesh (n = 18), permanent-barrier composite mesh [Composix(R) (n = 17)], permanent-barrier noncomposite mesh [DualMesh(R) (n = 14)], uncoated polypropylene mesh (n = 12), and biologic mesh (n = 8). Indications for laparoscopic re-exploration were recurrent ventral hernia (n = 58), chronic pain (n = 3), cholecystectomy (n = 3), parastomal hernia (n = 2), small bowel obstruction (n = 1), nephrectomy (n = 1), and Nissen fundoplication (n = 1). Adhesions to DualMesh were less tenacious (P < 0.05) compared to all other meshes. Surface area of adhesions to DualMesh were less (P < 0.05) than to Composix and to uncoated polypropylene mesh, but not to absorbable-barrier-coated and biologic meshes. Adhesiolysis time:mesh surface area was less (P < 0.05) for DualMesh compared to Composix, uncoated polypropylene, and biologic mesh, but not to absorbable-barrier-coated mesh. Adhesiolysis-related complications occurred in two (16.7%) (P = ns) patients with uncoated polypropylene mesh, one cystotomy and one enterotomy; both were repaired laparoscopically. There were two (16.7%) (P = ns) conversions to an open procedure: one converted patient had Composix (6.7%) and one had absorbable-barrier-coated mesh (5.9%). There were no adhesiolysis-related complications with these meshes. There were no adhesiolysis-related complications or conversions to open in the DualMesh or biologic mesh groups. CONCLUSIONS: Adhesion characteristics of mesh placed intraperitoneally and adhesiolysis-related complications during laparoscopic re-exploration after ventral hernia repair are associated with unique properties of the mesh and/or barrier.
机译：背景：这项研究的目的是表征可吸收和不可吸收屏障涂层的网片的粘附特性，并报告先前腹侧疝修补术在腹腔镜再次探查期间发生的与粘膜溶解有关的并发症。方法：根据IRB批准的方案，对先前腹膜内网状放置后接受腹腔镜再次探查的患者进行术中前瞻性分级，评估其粘附强度（0-4），粘附表面积（0 = 0％，10 = 100％）和比率时间对网孔表面积的影响（min / cm（2））。还记录了与粘膜溶解有关的并发症。数据以平均值+/- SD给出。使用t检验和Fisher精确检验确定统计学显着性（P <0.05）。结果：从2006年3月至2009年3月，有69例患者在事先腹膜内网状放置腹侧疝修补术后接受了腹腔镜手术。先前的网格是可吸收性屏障涂覆的网格（n = 18），永久性屏障复合网格[Composix®（n = 17）]，永久性屏障非复合网格[DualMesh®（n = 14）]，未涂布聚丙烯网（n = 12）和生物网（n = 8）。腹腔镜再次探查的指征是复发性腹侧疝（n = 58），慢性疼痛（n = 3），胆囊切除术（n = 3），口腔旁疝（n = 2），小肠梗阻（n = 1），肾切除术（ n = 1）和尼森胃底折叠术（n = 1）。与所有其他网格相比，对DualMesh的粘附力较弱（P <0.05）。与DualMesh的粘附表面积比对Composix和未涂覆的聚丙烯筛网的粘附表面积小（P <0.05），但对可吸收屏障涂覆的和生物筛网的粘附表面积则较小（P <0.05）。粘着时间：与Composix，未涂覆的聚丙烯和生物筛相比，DualMesh的筛表面积较小（P <0.05），但对可吸收阻隔的筛则没有。 2例（16.7％）（P = ns）未涂聚丙烯筛网，1例膀胱切开术和1例肠切开术的患者发生了与粘膜溶解相关的并发症。两者均经腹腔镜修复。有两次（16.7％）（P = ns）转换为开放手术：一名转换后的患者患有Composix（6.7％），而一名患者则具有可吸收屏障涂层的网片（5.9％）。这些网片没有与粘着溶解有关的并发症。在DualMesh或生物筛网组中没有与溶胶相关的并发症或可打开的并发症。结论：腹膜疝修补术后腹腔镜再探查期间腹膜内放置的网片的粘附特性和与粘膜溶解相关的并发症与网片和/或屏障的独特性质有关。

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