Ghanem Omar M, Zahiri Hamid R, Devlin Stephen, Sibia Udai, Park Adrian, Belyansky Igor
1 Department of General Surgery, Union Memorial Hospital , Baltimore, Maryland.
2 Department of General Surgery, Abdominal Wall Reconstruction Program, Anne Arundel Medical Center , Annapolis, Maryland.
J Laparoendosc Adv Surg Tech A. 2016 Feb;26(2):129-32. doi: 10.1089/lap.2015.0518. Epub 2016 Jan 27.
Subxiphoid hernias are a rare complication of median sternotomy with an incidence of 1%-4.2%. Repair of subxiphoid hernias is technically demanding with recurrence rates of 42% and 30% following open and laparoscopic repairs, respectively. We present a novel approach to the laparoscopic repair of subxiphoid hernias with improved overlap and fixation.
A novel technique for repairing subxiphoid hernias is described. The falciform ligament is dissected superiorly toward the diaphragm to allow proper subfascial positioning of the mesh with adequate overlap. Multiple nonabsorbable intracorporeal sutures are used to anchor the mesh to the diaphragm above the costal margins. Transfascial nonabsorbable sutures and tacks are used to fix the mesh to the anterior abdominal wall below the costal margin.
We have used this method in 4 patients with a mean age of 60.5 years and a female to male ratio of 4:0. The average hernia defect size was 20.5 cm(2), and the average duration of operation was 93 minutes. There were no reported postoperative complications or evidence of recurrence at the 1-year follow-up.
Laparoscopic repair of subxiphoid hernias can be safely accomplished with mesh sutured to the diaphragm for improved overlap and fixation with the goal of reducing recurrence rates.
剑突下疝是正中胸骨切开术的一种罕见并发症，发生率为1%-4.2%。剑突下疝的修复技术要求较高，开放修复和腹腔镜修复后的复发率分别为42%和30%。我们提出了一种腹腔镜修复剑突下疝的新方法，可改善重叠和固定效果。
描述了一种修复剑突下疝的新技术。将镰状韧带向上解剖至膈肌，以使补片在筋膜下正确定位并具有足够的重叠。使用多根不可吸收的体内缝线将补片固定于肋缘上方的膈肌。经筋膜不可吸收缝线和钉合器用于将补片固定于肋缘下方的前腹壁。
我们已将此方法应用于4例患者，平均年龄60.5岁，男女比例为4:0。平均疝缺损大小为20.5 cm²，平均手术时间为93分钟。在1年随访中，未报告术后并发症或复发迹象。
腹腔镜修复剑突下疝可通过将补片缝合至膈肌来安全完成，以改善重叠和固定效果，目标是降低复发率。
