Daes Jorge, Dennis Rodolfo J
Department of Minimally Invasive Surgery, Clinica Bautista, Carrera 38, Calle 71 Esquina, Barranquilla, Colombia.
Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotà, Colombia.
Surg Endosc. 2017 Feb;31(2):872-876. doi: 10.1007/s00464-016-5045-0. Epub 2016 Jun 22.
Proper defect closure during abdominal wall reconstruction (AWR) is a key to improving cosmetic and functional results, and reducing morbidity. We have completed the initial prospective evaluation of a technique we previously described and published: endoscopic subcutaneous anterior component separation (ACS) as an adjunct to mainly laparoscopic AWR. We now present the long-term clinical and imaging follow-up results.
Data were prospectively collected over a 3-year period (2012-2015) on patients who underwent AWR with endoscopic ACS. Inclusion criteria included the following: defects of 6-15 cm that are longer than wider; no skin dystrophy; no loss of domain; no active infection; no previous multiple, complex repairs; no previous multiple mesh repairs; and no high probability of severe adhesions. All patients were followed up clinically at 3, 6, and 12 months postoperatively and then annually. All patients underwent CT scanning of the abdominal wall (sagittal, axial, coronal, and 3D reconstruction) at 3 months and 1 year postoperatively and then annually.
Twenty consecutive patients underwent adjunctive endoscopic ACS: 17 laparoscopic AWRs, 2 open repairs, and 1 hybrid repair. Up to 38 months (mean 21 months) of follow-up, there were no ventral hernia recurrences or de novo hernias at the ACS site. One patient experienced partial primary closure failure. Morbidity consisted in one case each of hematoma, seroma, and transient neuralgia. Cosmetic results and patient satisfaction were excellent.
We confirmed that endoscopic subcutaneous ACS is a safe, effective, reliable, reproducible technique that facilitates primary closure of defects during AWR in selected patients.
腹壁重建（AWR）过程中正确的缺损闭合是改善美观和功能效果以及降低发病率的关键。我们已完成了对先前描述并发表的一项技术的初步前瞻性评估：内镜下皮下前入路分离术（ACS）作为主要腹腔镜AWR的辅助手段。我们现在展示长期临床和影像学随访结果。
前瞻性收集了2012年至2015年3年间接受内镜下ACS进行AWR的患者的数据。纳入标准包括：缺损6 - 15厘米，长大于宽；无皮肤营养不良；无区域丧失；无活动性感染；既往无多次复杂修复；既往无多次补片修复；无严重粘连的高可能性。所有患者术后3个月、6个月和12个月进行临床随访，之后每年随访一次。所有患者在术后3个月、1年及之后每年接受腹壁CT扫描（矢状位、轴位、冠状位和三维重建）。
连续20例患者接受了辅助内镜下ACS：17例腹腔镜AWR、2例开放修复和1例混合修复。随访长达38个月（平均21个月），ACS部位无腹疝复发或新发疝。1例患者出现部分一期闭合失败。并发症包括1例血肿、1例血清肿和1例短暂性神经痛。美观效果和患者满意度极佳。
我们证实内镜下皮下ACS是一种安全、有效、可靠、可重复的技术，有助于在选定患者的AWR过程中实现缺损的一期闭合。
