Praveenraj Palanivelu, Gomes Rachel Maria, Kumar Saravana, Senthilnathan Palanisamy, Parthasarathi Ramakrishnan, Rajapandian Subbiah, Palanivelu Chinnusamy
Department of Bariatric Surgery, Gem Hospital, Coimbatore, Tamil Nadu, India.
Department of Surgical Gastroenterology, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.
Obes Surg. 2016 Jun;26(6):1191-4. doi: 10.1007/s11695-015-1875-4.
Repair of recurrent ventral hernias (RVHs) has a high failure rate more so in the presence of obesity. The chronic increase in intra-abdominal pressure (IAP) associated with obesity might, in part, be an important implicating factor that needs to be addressed in these patients. Laparoscopic ventral hernia repair (LVHR) done with concomitant bariatric surgery in morbidly obese patients with RVHs may avoid multiple failures. We report our preliminary experience in treating RVHs in morbidly obese patients with laparoscopic intra-peritoneal onlay mesh (IPOM) repair and concomitant bariatric surgery.
A retrospective review of all patients with a RVH who underwent concomitant bariatric surgery and laparoscopic IPOM repair at our institution from 2009 to 2013 was performed. Demographic, operative, postoperative, and follow-up data were collected.
There were 23 patients included in the study. The mean BMI was 43.24. Fifteen patients had a previous open mesh repair, and eight had a laparoscopic IPOM repair. The patients had a median of 2 previous repairs (range 1-5 repairs). A laparoscopic sleeve gastrectomy was performed in 22 patients, and a laparoscopic Roux-en-Y gastric bypass was performed in one. The mean operating time was 112 min (65-220 min). The mean hospital stay was 3.3 days (2-8 days). A seroma was noted in four patients. No mesh infection or recurrence was noted at a median follow-up of 3.3 years (9 months to 5.5 years).
Laparoscopic IPOM repair done with concomitant bariatric surgery in morbidly obese patients with RVHs seems promising with a low rate of early recurrence.
复发性腹前壁疝（RVH）的修复失败率很高，肥胖患者中更是如此。肥胖相关的腹内压（IAP）慢性升高可能部分是这些患者需要解决的一个重要影响因素。对于患有RVH的病态肥胖患者，在进行减肥手术的同时进行腹腔镜腹前壁疝修补术（LVHR）可能避免多次修复失败。我们报告了我们使用腹腔镜腹膜内补片修补术（IPOM）修复并同时进行减肥手术治疗病态肥胖患者RVH的初步经验。
对2009年至2013年在我们机构接受减肥手术并同时进行腹腔镜IPOM修复的所有RVH患者进行回顾性研究。收集人口统计学、手术、术后和随访数据。
该研究纳入了23例患者。平均体重指数（BMI）为43.24。15例患者曾接受过开放补片修补术，8例曾接受过腹腔镜IPOM修补术。患者此前平均接受过2次修补（范围为1 - 5次修补）。22例患者接受了腹腔镜袖状胃切除术，1例接受了腹腔镜Roux-en-Y胃旁路术。平均手术时间为112分钟（65 - 220分钟）。平均住院时间为3.3天（2 - 8天）。4例患者出现了血清肿。在中位随访3.3年（9个月至5.5年）时未发现补片感染或复发。
对于患有RVH的病态肥胖患者，在进行减肥手术的同时进行腹腔镜IPOM修复似乎前景良好，早期复发率较低。
