Max Institute of Minimal Access, Metabolic and Bariatric Surgery, A unit of Devki Devi Foundation, Max Super Speciality Hospital, East Block, 2, Press Enclave Road, Saket, New Delhi, 110 017, India.
Hernia. 2011 Apr;15(2):131-9. doi: 10.1007/s10029-010-0747-z. Epub 2010 Nov 17.
Laparoscopic technique is now well established for ventral/incisional hernia repair. However several issues such as optimal fixation technique, occult hernias, management of inadvertent enterotomies, postoperative seromas and recurrence require appraisal.
A single centre retrospective review of 1,242 patients between January 1992 and June 2005 is described. All patients had laparoscopic ventral/incisional hernia repair (LVIHR) following a standardised protocol by five consultants and fellows in a dedicated minimal access surgery unit of a tertiary care hospital.
LVIHR was completed in 1,223 patients (98.5%). The average BMI was 32, mean defect size was 26.2 cm(2), mean operating time was 81 min and mean hospital stay was 1.9 days. The mean mesh to hernia ratio was 37.5. Occult hernias were observed in 203 (16.3%) patients and inadvertent enterotomies occurred in 21 (1.7%) patients. Mortality occurred in two patients, pulmonary embolism and cardiac dysrhythmia being the respective reasons. The most common sequel was early seroma formation (25%). Chronic pain occurred in 14.7% patients. Recurrence rate was 4.4%, which was associated with a higher BMI, use of staplers as fixation device, multiple defects and recurrent hernias. The mean follow up was 5.4 years; (range 2.4-10 years). The follow up rate was 78%.
LVIHR leads to low recurrence rates and low rates of wound and mesh infection. Occult hernias are diagnosed and optimally treated laparoscopically. However, chronic pain remains an unresolved issue.
腹腔镜技术现已广泛应用于治疗腹侧/切口疝。然而，一些问题如最佳固定技术、隐匿疝、意外肠切开的处理、术后血清肿和复发仍需评估。
描述了 1992 年 1 月至 2005 年 6 月期间在一个三级护理医院的微创外科治疗中心，由 5 位顾问和研究员进行的一项单中心回顾性研究。所有患者均根据标准方案接受腹腔镜下腹膜/切口疝修补术（LVIHR）。
1223 例患者（98.5%）完成 LVIHR。平均 BMI 为 32，平均缺损大小为 26.2cm²，平均手术时间为 81 分钟，平均住院时间为 1.9 天。平均网片与疝的比例为 37.5。203 例（16.3%）患者存在隐匿疝，21 例（1.7%）患者发生意外肠切开。2 例患者死亡，分别为肺栓塞和心律失常。最常见的并发症是早期血清肿形成（25%）。14.7%的患者出现慢性疼痛。复发率为 4.4%，与较高的 BMI、使用吻合器作为固定装置、多个缺损和复发性疝有关。平均随访时间为 5.4 年（范围 2.4-10 年）。随访率为 78%。
LVIHR 可降低复发率和伤口及网片感染率。隐匿疝可通过腹腔镜诊断并进行最佳治疗。然而，慢性疼痛仍是一个未解决的问题。
