Christoudias George, Nunziata Maritsa
Department of Surgery, Holy Name Medical Center, 741 Teaneck Rd, Teaneck, NJ, 07666, USA.
, 741 Teaneck Rd, Teaneck, NJ, 07666, USA.
Surg Endosc. 2016 Jun;30(6):2632-40. doi: 10.1007/s00464-015-4480-7. Epub 2015 Sep 3.
Despite the proven benefits of laparoscopic abdominal hernia repair (LAHR), only 25 % of elective ventral hernia repairs are currently performed using this method. This surprising trend may be due to the current limitations of LAHR including lack of defect closure, high seroma rates, and longer OR times. To address these challenges, a new method was developed that uses an innovative "finned" mesh configuration to combine defect closure via open dissection and laparoscopic underlay mesh placement.
A new "finned" mesh is sutured within the defect edges using a traditional open method and then approached laparoscopically for final fixation onto the peritoneal surface of the abdominal wall. The "fin" provides a perpendicular plane for suturing to avoid unintentional contact with any underlying viscera, centers the mesh symmetrically around the closed defect, and prevents mesh migration without stay sutures.
A retrospective review was performed on 108 consecutive patients that had a ventral, incisional, or umbilical hernia repaired using the "finned" mesh between 2007 and 2013. The mean follow-up was 40.83 months. Average operating time was 64.84 min (range 25-144 min) with an average length of stay of 0.80 days (range 0-10 days). There were two intraoperative complications (1.85 %): one small bowel injury and one unexplained incidence of tachycardia. Major post-operative complications included two recurrences (1.85 %) and one small bowel obstruction (0.96 %). Fourteen minor post-operative complications were observed (12.96 %), with the most common being post-operative ileus (n = 4) and urinary retention (n = 3). There were zero incidents of seroma, wound infection, or mesh infection in this study.
This innovative laparoscopic method incentivizes surgeons to embrace the technique and its universally accepted advantages by mitigating the most challenging aspects of LAHR. Promising results indicate a potential new standard of care for ventral hernia repair.
尽管腹腔镜腹壁疝修补术（LAHR）已被证明具有诸多益处，但目前仅有25%的择期腹疝修补术采用该方法。这一令人惊讶的趋势可能归因于LAHR目前存在的局限性，包括无法闭合缺损、血清肿发生率高以及手术时间较长。为应对这些挑战，人们开发了一种新方法，该方法采用创新的“带鳍”补片构型，通过开放解剖闭合缺损并进行腹腔镜补片底层放置。
使用传统开放方法将新型“带鳍”补片缝合于缺损边缘，然后通过腹腔镜将其最终固定于腹壁的腹膜表面。“鳍”提供了一个垂直平面用于缝合，以避免意外接触任何下方的内脏，使补片围绕闭合的缺损对称居中，并在不使用定位缝线的情况下防止补片移位。
对2007年至2013年间连续108例使用“带鳍”补片修复腹疝、切口疝或脐疝的患者进行了回顾性分析。平均随访时间为40.83个月。平均手术时间为64.84分钟（范围25 - 144分钟），平均住院时间为0.80天（范围0 - 10天）。术中发生了2例并发症（1.85%）：1例小肠损伤和1例不明原因的心动过速。主要术后并发症包括2例复发（1.85%）和1例小肠梗阻（0.96%）。观察到14例轻微术后并发症（12.96%），最常见的是术后肠梗阻（n = 4）和尿潴留（n = 3）。本研究中血清肿、伤口感染或补片感染的发生率为零。
这种创新的腹腔镜方法通过减轻LAHR最具挑战性的方面，促使外科医生接受该技术及其普遍认可的优势。有前景的结果表明腹疝修补术可能有了新的护理标准。
