Ferrari Giovanni Carlo, Miranda Angelo, Di Lernia Stefano, Sansonna Fabio, Magistro Carmelo, Maggioni Dario, Scandroglio Ildo, Costanzi Andrea, Franzetti Maurizio, Pugliese Raffaele
Surgery and Videolaparoscopy Department, Niguarda Hospital, Milan, Piazza Ospedale Maggiore 3, 20162, Milano, Italy.
Surg Endosc. 2008 May;22(5):1173-9. doi: 10.1007/s00464-007-9707-9. Epub 2007 Dec 20.
Minimal access surgery for incisional hernia repair is still debated, especially for large and giant wall defects. This study was undertaken to analyze the results of the use of the laparoscopic technique in incisional hernias smaller and larger than 15 cm of diameter.
From 2002 to 2007 a total of 100 patients with incisional hernia were operated on by laparoscopy and were included in this study. As much as 38 patients were obese, with a body mass index (BMI) > 30 kg/m(2). The mean follow-up span was 24 months (range = 2-58). The fascial defect was recurrent in 19 patients, in 13 after previous repair with mesh and in 6 after repair without mesh. The wall defect was larger than 15 cm in 25 patients and in 6 of them it was 20 cm or larger as measured from within the peritoneal cavity.
The mean operating time was 152 +/- 25 min (range = 45-275), and for defects larger than 15 cm it was 205 +/- 101 min (range = 85-540). Two patients with massive adhesions needed conversion to open surgery, one after an intraoperative injury of an intestinal loop. Postoperative complications occurred in 23 patients; local complications were 10. Pulmonary embolism caused death in one obese patient. Morbidity and hospital stay were similar in obese and nonobese patients and the differences were not statistically relevant (p > 0.05). The outcomes in patients with wall defects larger than 15 cm showed no significant difference with outcomes of the remaining patients with smaller defects (p > 0.05). Recurrence occurred in three cases, and in one case local infection led to removal of the mesh.
Minimal access procedures can provide good results in the repair of incisional hernia, even when the diameter is larger than 15 cm. Obesity is not a contraindication to laparoscopic repair. Further studies are expected to confirm these promising results.
切口疝修补的微创手术仍存在争议，尤其是对于大的和巨大的腹壁缺损。本研究旨在分析腹腔镜技术用于直径小于和大于15 cm的切口疝的治疗结果。
2002年至2007年，共有100例切口疝患者接受了腹腔镜手术并纳入本研究。其中38例为肥胖患者，体重指数（BMI）> 30 kg/m²。平均随访时间为24个月（范围 = 2 - 58个月）。19例患者存在筋膜缺损复发，其中13例为先前使用补片修补后复发，6例为未使用补片修补后复发。25例患者的腹壁缺损大于15 cm，其中6例从腹腔内测量其缺损为20 cm或更大。
平均手术时间为152 ± 25分钟（范围 = 45 - 275分钟），对于大于15 cm的缺损，手术时间为205 ± 101分钟（范围 = 85 - 540分钟）。2例有大量粘连的患者需要转为开放手术；1例因术中肠袢损伤而转为开放手术。23例患者发生术后并发症；局部并发症10例。1例肥胖患者死于肺栓塞。肥胖患者和非肥胖患者的发病率和住院时间相似，差异无统计学意义（p > 0.05）。腹壁缺损大于15 cm的患者与其余缺损较小的患者的治疗结果无显著差异（p > 0.05）。3例出现复发，1例因局部感染导致补片取出。
即使直径大于15 cm，微创手术在切口疝修补中也能取得良好效果。肥胖不是腹腔镜修补的禁忌证。期待进一步的研究证实这些令人鼓舞的结果。
