Clinical Analysis Of Three Surgical Methods For The Treatment Of Incisional Hernia

BackgroundIncisional hernia is one of the long-term complications after abdominal surgery,with the incidence of 11-20%.Once incisional hernia happens,it's difficult to cure after conservative treatment,and it may also lead to intestinal adhesion and intestinal strangulation,even life-threatening.Surgical treat is the only effective method.Repairs in open surgery is the traditional surgical method,and the application of laparoscopic incisional hernia repair is more and more widely with the continuous development of laparoscopic surgery and MESH.In recent years,some experts also suggest to combine the laparoscopic surgery with the open surgery,called hybrid technique(Hybrid Technique Incisional Hernia Repair).Although the surgical effects are reports in a large number of literatures,which kind of operation mode is the best method is still controversial because of the obvious difference.ObjectiveThe objective of this thesis was to comparatively analysis the clinical effects of the three kinds of patch repair operation:open incisional hernia repair,hybrid technique incisional hernia repair and laparoscopic incisional hernia repair,and direct surgeons to choose the best surgical approach.MethodsRetrospectively analysis the 86 patients treated by incisional hernia repairs in Sir Run Run Shaw Hospital affiliated to Medical College of Zhejiang University from January 2010 to June 2016,including 28 patients by OIHR(Open Incisional Hernia Repair),27 patients by HTIHR(Hybrid Technique Incisional Hernia Repair),31 patients by LIHR(Laparoscopic Incisional Hernia Repair).After adjusting the differences among the age,sex,BMI,ASA grade,et al,comparatively analysis some clinical indicators after surgery,to analysis whether there is any statistically significant differences.The measurement data included operative time,hospitalization time,et al.The count data included seroma,wound infection,pulmonary infection,abdominal pain and other complications and recurrence.ResultsThere was no significant difference between the three groups in general data,incisional hernia type,intraoperative bleeding,hospitalization time and complications.Compared with the other groups,LIHR group has small abdominal wall defect(P<0.05),short postoperative eating time(ie,intestinal recovery time)(P<0.05),the less of the use of analgesics(P<0.05)with satistical significance.The LIHR group has less operative time compared with OIHR group,but the difference is not significant.Compared with LIHR group,the operation time was longer in HTIHR group(P<0.05).The recurrence rate in OIHR group was 21.4%(6/28),in LIHR was 3.2%(1/31),with no recurrence in HTIHR,and with statistical significance.ConclusionsLIHR and HTIHR are safe and effective and can replace the traditional open surgery.LIHR has little injury,short operative time,less pain,quicker recovery than OIHR.For more complicated incisional hernia with large defect and recurrent hernia,HTIHR combines the advantages of LIHR and OIHR,so it can improve the curative effect and reduce the recurrence rate,and may balance the hign cost of hospitalization.In addition,with the continuous development of repair materials,fixed materials,surgical methods,especially the robot surgery and postoperative evaluation,the abdominal incisional hernia surgery will achieve better and better results.