Ferrari G C, Miranda A, Sansonna F, Magistro C, Di Lernia S, Maggioni D, Franzetti M, Pugliese R
Surgery and Videolaparoscopy Department, Niguarda Hospital, Milan, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Hernia. 2008 Dec;12(6):571-6. doi: 10.1007/s10029-008-0410-0. Epub 2008 Aug 8.
Despite good results in terms of safety and minimal recurrence ensured by laparoscopy in the management of incisional hernias, the use of minimally invasive techniques for large incisional wall defects is still controversial.
Between 2002 and 2008 as many as 36 patients with abdominal wall defects > or = 15 cm were managed laparoscopically in our institution. The wall defects were > or = 20 cm in eight cases. The diameter of parietal defects was measured from within the peritoneal cavity. None had loss of domain. Body mass index (BMI) for 18 patients was > or = 30 kg/m(2).
The mean duration of operations was 195 +/- 28 min (range 75-540). One patient needed conversion for ileal injury and massive adhesions. Post-operative complications occurred in nine patients; there were six surgical complications. Morbidity in obese and non-obese patients was not statistically different (p > 0.05). There was no postoperative death. Mean hospital stay was 4.97 +/- 3.4 days (range 2-18). Mean follow up was 28 months (range 2-68) and only one hernia recurrence was observed.
Minimum-access procedures can provide good results in the repair of giant incisional hernia. Obesity is not a contraindication to laparoscopic repair. Further studies are expected to confirm our promising results.
尽管腹腔镜手术在切口疝治疗中确保了良好的安全性和极低的复发率，但对于大的切口壁缺损采用微创技术仍存在争议。
2002年至2008年期间，我院对多达36例腹壁缺损≥15 cm的患者进行了腹腔镜手术治疗。其中8例患者的腹壁缺损≥20 cm。通过腹腔内测量壁层缺损的直径。所有患者均无腹腔内容物无法回纳的情况。18例患者的体重指数（BMI）≥30 kg/m²。
手术平均时长为195±28分钟（范围75 - 540分钟）。1例患者因回肠损伤和广泛粘连需要中转开腹。9例患者出现术后并发症，其中6例为手术相关并发症。肥胖患者和非肥胖患者的并发症发生率无统计学差异（p>0.05）。无术后死亡病例。平均住院时间为4.97±3.4天（范围2 - 18天）。平均随访时间为28个月（范围2 - 68个月），仅观察到1例疝复发。
微创手术在巨大切口疝修复中可取得良好效果。肥胖并非腹腔镜修复的禁忌证。期待进一步研究证实我们的良好结果。
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