Chan Daniel Leonard, Talbot Michael Leonard, Chen Zhuoran, Kwon Sebastianus Chang Mo
Upper Gastrointestinal Surgery Unit, St George Hospital, Sydney, New South Wales, Australia; UNSW Department of Surgery, St George Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
ANZ J Surg. 2014 Jul-Aug;84(7-8):581-3. doi: 10.1111/ans.12174. Epub 2013 May 3.
Obesity is a significant risk factor in abdominal hernia occurrence and recurrence. In patients having bariatric surgery, there are no clear guidelines as to whether repair should be done simultaneously, especially if procedures involve division or resection of part of the gastrointestinal tract.
A retrospective case series review over a 6-year period to December 2012 from a prospective database was conducted. As per existing practice for bariatric procedures, patients were followed up indefinitely. Short- and long-term outcomes were analysed.
Forty-five patients underwent combined laparoscopic bariatric surgery and abdominal wall hernia repair. Of these, 36 had resection procedures (gastric bypass or sleeve gastrectomy) and 9 had non-resection procedures (gastric banding). The mean operative time was 151 min and the mean length of stay was 3 days. Two patients developed post-operative mesh seroma infections. To date, there have been no mesh removals or recurrent hernias. There was no mortality in this series.
This study demonstrated a low rate of mesh infection (4.44%) at a median follow-up of 13 months, even when a resectional procedure was performed (5.56%). These results suggest the possible viability and reasonable short-/long-term outcomes of simultaneous laparoscopic abdominal wall hernia repair during bariatric surgical procedures, even if the surgery involved division or resection of part of the gastrointestinal tract. This topic is an area of clinical research that warrants further study.
肥胖是腹外疝发生和复发的重要危险因素。对于接受减肥手术的患者，对于是否应同时进行修补手术尚无明确指南，尤其是当手术涉及部分胃肠道的分离或切除时。
对一个前瞻性数据库进行回顾性病例系列研究，时间跨度为6年，至2012年12月。按照减肥手术的现有做法，对患者进行无限期随访。分析短期和长期结果。
45例患者接受了腹腔镜减肥手术和腹壁疝修补联合手术。其中，36例进行了切除手术（胃旁路手术或袖状胃切除术），9例进行了非切除手术（胃束带术）。平均手术时间为151分钟，平均住院时间为3天。2例患者发生术后补片血清肿感染。迄今为止，没有补片取出或疝复发的情况。该系列中无死亡病例。
本研究表明，即使进行了切除手术（5.56%），在中位随访13个月时补片感染率仍较低（4.44%）。这些结果表明，在减肥手术过程中同时进行腹腔镜腹壁疝修补术可能具有可行性，且短期/长期结果合理，即使手术涉及部分胃肠道的分离或切除。这一主题是一个值得进一步研究的临床研究领域。
