Lorente-Herce J M, Marín-Morales J, Jiménez-Vega F J, Ruíz-Juliá M L, Claro-Alves B M, Fernández-Zulueta A, Gallardo-García P A, Marrero-Cantera S, De Quinta-Frutos R
Ambulatory Surgery Unit, Valme University Hospital, Sevilla, Spain,
Hernia. 2015 Jun;19(3):487-92. doi: 10.1007/s10029-014-1229-5. Epub 2014 Mar 9.
The high prevalence of incisional hernias and an average stay of 3-10 days for open procedures have made this pathology both a health problem and an economic issue. A protocol was developed for performing this procedure in an Ambulatory Surgery Center (ASC) with extended recovery.
From January 2000 to December 2011, data about all laparoscopic incisional hernia repairs were gathered prospectively. The patients' clinical features, hernia type, intraoperative and postoperative complications and reasons for hospital admission are studied.
A total of 259 patients have been operated for incisional hernia (185) or recurrent hernioplasty (74) in our ASC. Laparoscopic repair was successful in 254 patients (98.07 %). Conversion to open surgery was necessary in five patients (1.93 %). A total of 50 patients (19.69 %) in whom surgery was completed laparoscopically were discharged the same day of surgery, 179 (70.47 %) at 24 h and 25 (9.84 %) required a stay of over 24 h. Postoperative pain was severe in 10 % of patients, moderate in 40 %, and mild in 50 %. Complications, mostly minor and self-limiting, were observed in 25 patients (9.84 %) during hospital stay. Five major complications that occured were: bile peritonitis, an acute peritonitis, due to an inadvertent intestinal perforation, and one intestinal obstruction by partial detachment of the mesh, an intra-abdominal hematoma and a colo-cutaneous fistula. There were no deaths in the series. The mean follow-up of patients was 29.35 months (range 12-129 months). The recurrence rate was 7.03 % (n = 18). Four trocar-site hernias were detected.
It is essential to create a protocol with selection criteria that take into account the patient, his entourage, the anesthetic-surgical procedure, and a team dedicated to surgical laparoscopic surgery in an ASC with extended recovery to achieve good results in terms of morbidity and patient safety.
切口疝的高发病率以及开放手术平均3 - 10天的住院时间，使得这种病症既成为一个健康问题，也成为一个经济问题。因此制定了一项在具有延长康复设施的门诊手术中心（ASC）进行该手术的方案。
2000年1月至2011年12月，前瞻性收集所有腹腔镜切口疝修补术的数据。研究患者的临床特征、疝类型、术中及术后并发症以及住院原因。
在我们的门诊手术中心，共有259例患者接受了切口疝修补术（185例）或复发性疝修补术（74例）。254例患者（98.07%）腹腔镜修补成功。5例患者（1.93%）需要转为开放手术。共有50例（19.69%）腹腔镜手术完成的患者在手术当天出院，179例（70.47%）在24小时出院，25例（9.84%）需要住院超过24小时。10%的患者术后疼痛严重，40%为中度，50%为轻度。住院期间25例患者（9.84%）出现并发症，大多为轻微且自限性的。发生的5例主要并发症为：胆汁性腹膜炎，一种因意外肠穿孔导致的急性腹膜炎，以及1例因补片部分脱离导致的肠梗阻、1例腹腔内血肿和1例结肠皮肤瘘。该系列中无死亡病例。患者的平均随访时间为29.35个月（范围12 - 129个月）。复发率为7.03%（n = 18）。检测到4例套管针穿刺部位疝。
制定一个包含选择标准的方案至关重要，该标准要考虑患者及其家属、麻醉 - 手术操作，以及一个致力于在具有延长康复设施的门诊手术中心进行腹腔镜手术的团队，以便在发病率和患者安全方面取得良好效果。
