Harbor-UCLA Medical Center, Torrance, CA, USA,
Hernia. 2013 Oct;17(5):633-8. doi: 10.1007/s10029-013-1145-0. Epub 2013 Aug 9.
Totally Laparoscopic Abdominal Wall Reconstruction (TLAWR) combines the laparoscopic component separation and the laparoscopic ventral hernia repair, with the purpose of further increasing the benefits of a minimally invasive procedure. However, neither the patient selection criteria nor the long-term results of this technique have been reported. Our objective is to discuss our experience with five patients who received a TLAWR.
All patients with a midline incisional hernia who underwent a TLAWR from September 2008 to October 2009 were retrospectively reviewed for early and late postoperative complications.
A total of five patients underwent the procedure, with a mean age of 48.6 ± 7.9 years. The mean length of stay was 9.2 ± 5.4 days, and follow-up was 12.3 ± 6.8 months. The mean defect size was 175.8 ± 56.2 cm(2). There were no early or late wound complications. Two patients had an early respiratory complication, and one patient developed a port site hernia and small bowel obstruction early after procedure, which required a re-operation. Three patients (60 %) experienced a recurrence. Possible risk factors for recurrence include previous failed hernia repair, loss of domain, large hernias and close proximity to bony structures.
Although TLAWR is feasible and improves wound complications, it may be associated with higher recurrence. Appropriate patient selection is imperative in order for the patient to benefit from this technique.
完全腹腔镜腹壁重建（TLAWR）结合了腹腔镜间隔分离术和腹腔镜腹疝修补术，旨在进一步增加微创手术的益处。然而，该技术既没有患者选择标准，也没有长期结果的报道。我们的目的是讨论我们对 5 名接受 TLAWR 治疗的患者的经验。
回顾性分析 2008 年 9 月至 2009 年 10 月期间接受 TLAWR 的中线切口疝患者的早期和晚期术后并发症。
共有 5 名患者接受了该手术，平均年龄为 48.6±7.9 岁。平均住院时间为 9.2±5.4 天，随访时间为 12.3±6.8 个月。平均缺损大小为 175.8±56.2cm²。无早期或晚期伤口并发症。2 例患者发生早期呼吸并发症，1 例患者术后早期出现切口疝和小肠梗阻，需再次手术。3 名患者（60%）出现复发。复发的可能危险因素包括先前疝修补术失败、领域丧失、巨大疝和靠近骨结构。
尽管 TLAWR 是可行的，并且可以改善伤口并发症，但它可能与更高的复发率相关。为了让患者从该技术中受益，适当的患者选择至关重要。
