Marx L, Raharimanantsoa M, Mandala S, D'Urso A, Vix M, Mutter D
Department of Digestive and Endocrine Surgery, IRCAD/EITS, IHU Strasbourg, NHC - Pôle Hépato-Digestif, University Hospital of Strasbourg, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
Surg Endosc. 2014 Dec;28(12):3310-4. doi: 10.1007/s00464-014-3607-6. Epub 2014 Jul 10.
Incisional and ventral hernias are common surgical indications. Their management is associated with significant complications and recurrences in open surgery (15-25%). Since laparoscopy has become a standard in bariatric surgery, there has been a natural trend to treat obese patients with parietal wall defects laparoscopically. The aim of our study was to evaluate the feasibility and the results of the laparoscopic management of parietal wall defects in patients with a BMI >35.
A series of 79 patients were included. Data were acquired prospectively and analyzed retrospectively. The surgical procedure was standardized: 3 ports, mesh type (Parietex™ Composite mesh, Covidien, France), fixation with non-absorbable transfascial sutures, and tackers. Complications were evaluated.
Out of 79 patients (29 men, 50 women), 43 had umbilical and 36 had ventral hernias. Mean age was 52.4 years, and mean BMI was 40.83 kg/m(2). Mean postoperative hospital stay was 2 days. Postoperative pain evaluated by visual analog scale was 2.86. No intraoperative complications or deaths occurred. Seven postoperative complications occurred (8.86%): two parietal wall hematomas treated by radiological embolization, two significant cases of postoperative pain, one postoperative obstruction, one spontaneously resolved respiratory failure, and one early (day 1) parietal wall defect with immediate reoperation. Postoperative seroma rate was 26.58% (21 patients, all of whom were treated conservatively). Postoperative follow-up was 18.10 months (1-84 months), and recurrence rate was 3.8% (3 patients).
This study confirms the feasibility and safety of the laparoscopic approach for ventral hernias in morbidly obese patients. Recurrence rates (3.8%) appeared lower than the ones observed in the literature (15-25%). Postoperative hemorrhage and port-site hernia are specific complications of this approach. Postoperative hospital stay is low (2 days) as compared to open surgery. Laparoscopic management of parietal wall defects should be considered a standard option in morbidly obese patients.
切口疝和腹疝是常见的手术适应症。其治疗在开放手术中会伴有显著的并发症和复发率（15%-25%）。自从腹腔镜手术成为减重手术的标准术式以来，对于肥胖且伴有腹壁缺损的患者，采用腹腔镜治疗便成为一种自然趋势。我们研究的目的是评估体重指数（BMI）>35的患者采用腹腔镜治疗腹壁缺损的可行性及效果。
纳入79例患者。前瞻性收集数据并进行回顾性分析。手术操作标准化：采用3个穿刺孔、Parietex™复合补片（法国科惠医疗公司）、用不可吸收的经筋膜缝线及钉合器固定。对并发症进行评估。
79例患者（29例男性，50例女性）中，43例为脐疝，36例为腹疝。平均年龄52.4岁，平均BMI为40.83kg/m²。术后平均住院时间为2天。采用视觉模拟评分法评估的术后疼痛评分为2.86。术中无并发症及死亡发生。发生7例术后并发症（8.86%）：2例腹壁血肿经放射栓塞治疗，2例严重术后疼痛，1例术后肠梗阻，1例自发缓解的呼吸衰竭，1例早期（第1天）腹壁缺损并立即再次手术。术后血清肿发生率为26.58%（21例患者，均采用保守治疗）。术后随访18.10个月（1-84个月），复发率为3.8%（3例患者）。
本研究证实了腹腔镜治疗病态肥胖患者腹疝的可行性和安全性。复发率（3.8%）似乎低于文献报道（15%-25%）。术后出血和穿刺孔疝是该手术方式的特定并发症。与开放手术相比，术后住院时间较短（2天）。对于病态肥胖患者，腹腔镜治疗腹壁缺损应被视为一种标准选择。
