| 摘要 |
Hernia repair is one of the most common surgical procedures; the evolution of
hernia management reflects the development of surgery. Recently, due to the
advance in repair techniques and utilization of a prosthetic mesh, the overall
recurrence rate has been reduced from 15% to less than 5%. An ideal hernia repair
should have short convalescence, low recurrence, low complications, and minimal
postoperative pain. Most tissue to tissue repairs, which were still popular two
decades ago, have now been replaced by open tension-free repairs and endoscopic
repairs. Tension-free repairs are the most popular repairs, representing 70% of
repairs performed in developed countries, followed by endoscopic repairs, which
represent 15-20% of repairs. The former includes the Lichtenstein repair (plain flat
mesh, for 25 years), the Plug and Patch repair (for 20 years), the Kugel posterior
patch (for 15 years) and Prolene Hernia System (for 11 years). In the year of 2009,
about half of the adult herniorraphy in Taiwan utilized some kind of mesh. The
important concepts in herniorraphy today are: treating the myopectineal orifice as a
whole, using prosthetic material to replace or re-enforce the attenuated abdominal
fascia and muscles, to reduce the suture line tension and postoperative pain, and to
prevent recurrences. However, hernioplasties using a prosthetic mesh are not
without complications. The mesh will evolve rapidly and always improve in material,
configuration, and three-dimentional design. Only those surgeons who know
thoroughly the details of different kinds of mesh, including the interaction between
the mesh and human body after they are implanted, can select the best and most
appropriate repair for each of their individual patients. Further basic studies on
collagen metabolism and related genetic anomalies may provide nonsurgical
treatment of groin hernias. |
