Raftopoulos I, Courcoulas A P
Division of Minimally Invasive, Bariatric, and General Surgery, UPMC Shadyside & Magee-Women's Hospitals, University of Pittsburgh, 5200 Centre Avenue, Suite 715, Pittsburgh, PA 15232, USA.
Surg Endosc. 2007 Dec;21(12):2293-7. doi: 10.1007/s00464-007-9406-6. Epub 2007 May 24.
Laparoscopic ventral hernia repair (LVHR) for morbidly obese patients with a body mass index (BMI) exceeding 35 kg/m(2) has not been well investigated.
Hernia recurrence was evaluated by surveillance computed tomography. A p value less than 0.05 was considered significant.
Between 2003 and 2006, LVHR was attempted for 27 patients with a BMI exceeding 35 kg/m(2). There was one conversion to open surgery (3.7%). The 27 patients included 8 men (29.6%) and 19 women (70.4%) with a mean age of 48 years (range, 33-73 years). The mean BMI was 46.9 kg/m(2) (range, 35-70 kg/m(2)). Nine patients (33%) were superobese (BMI > 50 kg/m(2)), and five patients (22.7%) underwent emergency LVHR because of small bowel obstruction. Concomitant LVHR with laparoscopic gastric bypass (LGB) was performed for 13 patients (48%). Primary, incisional, or recurrent incisional ventral hernia was present in 7 (26%), 15 (55%), and 5 (19%) patients, respectively. A large hernia (>50 cm(2)) was found in 20 patients (74%). The mesh used was porcine submucosal small intestine extracellular matrix for 15 patients (57%), Gore-Tex for 9 patients (35%), and Composix for 2 patients (8%). The mean hernia size was 158 cm(2 )(range, 12-806 cm(2)), and the mean mesh size was 374 cm(2) (range, 117-2,400 cm(2)). The mean operative time was 190 min (range, 80-480 min), and the mean hospital length of stay (LOS) was 3.6 days (range, 1-11 days). Minor or major complications occurred in seven patients (25.9%), and five patients (18.5%) experienced recurrence during a mean follow-up period of 14.9 months (range, 3-32 months). Emergency setting, BMI, concomitant LGB, hernia type, hernia size, and mesh type had no statistically significant effect on operative time, LOS, morbidity, or recurrence rates.
For morbidly obese patients, LVHR is safe and effective, but it is associated with higher likelihood of recurrence, and patients should be appropriately informed.
对于体重指数（BMI）超过35kg/m²的病态肥胖患者，腹腔镜腹疝修补术（LVHR）尚未得到充分研究。
通过监测计算机断层扫描评估疝复发情况。p值小于0.05被认为具有统计学意义。
2003年至2006年期间，对27例BMI超过35kg/m²的患者尝试进行LVHR。有1例转为开放手术（3.7%）。27例患者包括8名男性（29.6%）和19名女性（70.4%），平均年龄48岁（范围33 - 73岁）。平均BMI为46.9kg/m²（范围35 - 70kg/m²）。9例患者（33%）为超级肥胖（BMI > 50kg/m²），5例患者（22.7%）因小肠梗阻接受急诊LVHR。13例患者（48%）同时进行了腹腔镜胃旁路术（LGB）和LVHR。原发性、切口性或复发性切口腹疝分别见于7例（26%）、15例（55%）和5例（19%）患者。20例患者（74%）发现有大疝（>50cm²）。15例患者（57%）使用猪黏膜下层小肠细胞外基质补片，9例患者（35%）使用戈尔特斯补片，2例患者（8%）使用Composix补片。平均疝大小为158cm²（范围12 - 806cm²），平均补片大小为374cm²（范围117 - 2400cm²）。平均手术时间为190分钟（范围80 - 480分钟），平均住院时间（LOS）为3.6天（范围1 - 11天）。7例患者（25.9%）发生轻微或严重并发症，5例患者（18.5%）在平均14.9个月（范围3 - 32个月）的随访期内出现复发。急诊情况、BMI、同时进行的LGB、疝类型、疝大小和补片类型对手术时间、LOS、发病率或复发率无统计学显著影响。
对于病态肥胖患者，LVHR是安全有效的，但复发可能性较高，应适当告知患者。
