Lomanto D, Iyer S G, Shabbir A, Cheah W-K
Minimally Invasive Surgical Centre, Department of Surgery, National University Hospital, 5 Lower Kent Ridge Road, Singapore 119074, Singapore.
Surg Endosc. 2006 Jul;20(7):1030-5. doi: 10.1007/s00464-005-0554-2. Epub 2006 May 15.
An incisional hernia develops in 3% to 13% of laparotomy incisions, with primary suture repair of ventral hernias yielding unsatisfactory results. The introduction of a prosthetic mesh to ensure abdominal wall strength without tension has decreased the recurrence rate, but open repair requires significant soft tissue dissection in tissues that are already of poor quality as well as flap creation, increasing complication rates and affecting the recurrence rate. A minimally invasive approach was applied to the repair pf ventral hernias, with the expectation of earlier recovery, fewer postoperative complications, and decreased recurrence rates. This prospective study was performed to objectively analyze and compare the outcomes after open and laparoscopic ventral hernia repair.
The outcomes for 50 unselected patients who underwent laparoscopic ventral hernia repair were compared with those for 50 consecutive unselected patients who underwent open repair. The open surgical operations were performed by the Rives and Stoppa technique using prosthetic mesh, whereas the laparoscopic repairs were performed using the intraperitoneal onlay mesh (IPOM) repair technique in all cases.
The study group consisted of 100 patients (82 women and 18 men) with a mean age of 55.25 years (range, 30-83 years). The patients in the two groups were comparable at baseline in terms of sex, presenting complaints, and comorbid conditions. The patients in laparoscopic group had larger defects (93.96 vs 55.88 cm2; p = 0.0023). The mean follow-up time was 20.8 months (95% confidence interval [CI], 18.5640-23.0227 months). The mean surgery durations were 90.6 min for the laparoscopic repair and 93.3 min for the open repair (p = 0.769, nonsignificant difference). The mean postoperative stay was shorter for the laparoscopic group than for the open hernia group (2.7 vs 4.7 days; p = 0.044). The pain scores were similar in the two groups at 24 and 48 h, but significantly less at 72 h in the laparoscopic group (mean visual analog scale score, 2.9412 vs 4.1702; p = 0.001). There were fewer complications (24%) and recurrences (2%) among the patients who underwent laparoscopic repair than among those who had open repair (30% and 10%, respectively).
The findings demonstrate that laparoscopic ventral hernia repair in our experience was safe and resulted in shorter operative time, fewer complications, shorter hospital stays, and less recurrence. Hence, it should be considered as the procedure of choice for ventral hernia repair.
剖腹手术切口疝的发生率为3%至13%，腹疝的一期缝合修复效果不理想。引入人工合成补片以确保腹壁无张力的强度，降低了复发率，但开放修复需要在质量已经较差的组织中进行大量软组织分离以及皮瓣制作，增加了并发症发生率并影响复发率。采用微创方法修复腹疝，期望能更早恢复、减少术后并发症并降低复发率。本前瞻性研究旨在客观分析和比较开放与腹腔镜腹疝修补术后的结果。
将50例未经选择接受腹腔镜腹疝修补术的患者与50例连续未经选择接受开放修补术的患者的结果进行比较。开放手术采用里夫斯和斯托帕技术使用人工合成补片进行，而所有腹腔镜修补均采用腹腔内补片植入修补（IPOM）技术。
研究组由100例患者（82例女性和18例男性）组成，平均年龄55.25岁（范围30 - 83岁）。两组患者在性别、主诉和合并症方面基线可比。腹腔镜组患者的缺损更大（93.96 vs 55.88 cm²；p = 0.0023）。平均随访时间为20.8个月（95%置信区间[CI]，18.5640 - 23.0227个月）。腹腔镜修补的平均手术时间为90.6分钟，开放修补为93.3分钟（p = 0.769，无显著差异）。腹腔镜组的平均术后住院时间比开放疝修补组短（2.7天对4.7天；p = 0.044）。两组在24小时和48小时时疼痛评分相似，但腹腔镜组在72小时时显著更低（平均视觉模拟评分，2.9412对4.1702；p = 0.001）。接受腹腔镜修补的患者并发症（24%）和复发（2%）比接受开放修补的患者少（分别为30%和10%）。
研究结果表明，根据我们的经验，腹腔镜腹疝修补术是安全的，且手术时间更短、并发症更少、住院时间更短、复发更少。因此，应将其视为腹疝修补的首选术式。
