Application of PTFE liner in ventral hernia repair case
Ventral hernia is the most common general surgery disease, and most of them are inguinal hernia, and surgical treatment is the accepted cure.
In 2021, a total of 859 tension-free hernia repairs were performed in our department, 767 cases (89.3%) in men and 92 cases (10.7%) in women. Among them, 731 cases (85.0%) were inguinal hernia, 86 cases (10.0%) were inguinal hernia, 13 cases (1.5%) were femoral hernia, 12 cases were incisional hernia, 9 cases were ventral white line hernia, and 8 cases were umbilical hernia. There were 27 cases of incarcerated hernia (no intestinal necrosis occurred), accounting for 3.1%.
All cases were treated with expanded polytetrafluoroethylene ptfe lined tubes manufactured by CHINA AOKERAY . The inguinal hernia procedure was performed according to the standard Lichtenstein procedure. For incisional hernia, white line hernia and umbilical hernia, the patch was placed in the peritoneum and in front of the posterior sheath, under the anterior sheath or under the skin according to the intraoperative situation after freeing and high ligation of the hernia sac, and all of them could heal in one stage. In femoral hernia, a transinguinal approach is used, after incising the tendon membrane of the external oblique muscle, the round ligament of the uterus, the internal oblique muscle and the joint tendon are drawn upward and outward to reveal the posterior wall, the hernia sac is found at the femoral ring and freed, the sac is incised and the contents are examined and returned to the abdominal cavity, the distal redundant sac is excised, the proximal end is tightly sutured and then turned inward, the transverse abdominal fascia is sutured, and then the patch is placed in the posterior wall, laid flat and sutured to the joint tendon, the pubic commissure ligament and the inguinal ligament. The patch was then placed in the posterior wall, sutured to the joint tendon, pubic comb ligament and inguinal ligament, and finally sutured to the outer layer of tissue and skin. The outer layer of tissue and skin were closed with 2-0 PROLENE sutures. The average operating time was 95 min, and the longest hospital stay was 16 d, the shortest was 3 d, and the average was 4.6 d. The average follow-up period was 10-60 months, and the average was 30 months. 44 patients had postoperative complications, including 8 cases of urinary retention, 10 cases of postoperative hematoma or plasmacytoma, 4 cases of fat liquefaction in the wound, and 4 cases of incisional sinus tract (3 of which were partially removed and 1 of which was completely removed, all of which were related to There were 15 cases of scrotal swelling, 3 cases of mild postoperative pain, and no recurrent cases.
Tension-free hernia repair was first proposed by Lichtenstein in 1989 in the American Journal of Surgery and was regarded as a “milestone” in hernia repair in the 20th century. It is the best surgical approach for tension-free hernia repair today because it is a tension-free suture repair that maximizes the restoration of normal anatomical and physiological function of the patient’s organs and eliminates the anatomical basis for hernia recurrence, requiring only minimal suturing during surgery . Polytetrafluoroethylene PTFE is completely fluorinated and specially treated expanded PTFE fibers can exhibit a porous structure that can be made into a soft, bendable, non-abrasive material. The greatest advantage of expanded PTFE liner is that it is flexible, the forces in all directions are in balance, it can be cut and covered as needed, presenting fiber continuity with a unique porous permeable microstructure into which cells can infiltrate, good histocompatibility, more superior mechanical properties, light postoperative wound pain for patients, small scar formation, better comfort, and is a tension-free hernia repair Ideal material