Mercoli Henry, Tzedakis Stylianos, D'Urso Antonio, Nedelcu Marius, Memeo Riccardo, Meyer Nicolas, Vix Michel, Perretta Silvana, Mutter Didier
Digestive and Endocrine Surgery Department, Nouvel Hôpital Civil, Strasbourg University Hospital, Institut de Recherche contre les Cancers de l'Appareil Digestif (IRCAD), Institute of Image-Guided Surgery (IHU Mix-Surg), 1 place de l'Hôpital, 67000, Strasbourg, France.
Biostatistics and Public Health Department, Hôpital Civil, Strasbourg University Hospital, Strasbourg, France.
Surg Endosc. 2017 Mar;31(3):1469-1477. doi: 10.1007/s00464-016-5140-2. Epub 2016 Aug 5.
Laparoscopic ventral hernia repair (LVHR) has become widely used. This study evaluates outcomes of LVHR, with particular reference to complications, seromas, and long-term recurrence.
A review of a prospective database of consecutive patients undergoing LVHR with intraperitoneal onlay mesh (IPOM) was performed at a single institution. Patient's characteristics, surgical procedures, and postoperative outcomes were analyzed and related to long-term recurrence.
From 2005 to 2014, 417 patients underwent LVHR. Mean age and body mass index (BMI) were 54 years and 31 kg/m. Mesh fixation was carried out with transfascial sutures, completed with absorbable tacks (72 %), metal tacks (24 %), or intraperitoneal sutures (4 %). Intraoperative complications occurred in three patients. Overall morbidity included 8.25 % of minor complications and 2.5 % of major complications without mortality. The overall recurrence rate was 9.8 %. Median time for recurrence was 15.3 months (3-72) and median follow-up was 31.6 months (8-119). In a multivariate analysis, previous interventions (OR 1.44; CI 1.15-1.79; p = 0.01), postoperative complications (OR 2.57; CI 1.09-6.03; p = 0.03), and Clavien-Dindo score >2 (OR 1.43; CI 1.031-1.876; p = 0.02) appeared as independent prognostic factors of recurrence. Minor complications were associated with 14.7 % of recurrence and major complications with 30 % of recurrence. Emergency LVHR (6 %) did not increase the rate of complications. Overall seroma rate was 18.7 %, with 1.4 % of persisting or complicated seroma. BMI (OR 1.05; CI 1.01-1.08; p = 0.026) and vascular surgery history (OR 5.74; CI 2.11-15.58; p < 0.001) were independent predictive factors for seroma. Recurrence did not appear to be related to seroma.
LVHR combines the benefits of laparoscopy with those of mesh repair. Seroma formation should no longer be considered as a complication. It is spontaneously regressive in most cases. Postoperative complications and their degree of severity appear to be independent prognostic factors for recurrence, which can be limited with a standardized technique and may make IPOM-LVHR a reference procedure.
腹腔镜腹疝修补术（LVHR）已得到广泛应用。本研究评估LVHR的疗效，特别关注并发症、血清肿和长期复发情况。
在单一机构对接受腹腔镜腹膜内补片修补术（IPOM）的连续LVHR患者的前瞻性数据库进行回顾。分析患者特征、手术过程和术后结果，并与长期复发情况相关联。
2005年至2014年，417例患者接受了LVHR。平均年龄和体重指数（BMI）分别为54岁和31kg/m²。补片通过经筋膜缝线固定，并用可吸收钉（72%）、金属钉（24%）或腹膜内缝线（4%）完成。3例患者发生术中并发症。总体发病率包括8.25%的轻微并发症和2.5%的严重并发症，无死亡病例。总体复发率为9.8%。复发的中位时间为15.3个月（3 - 72个月），中位随访时间为31.6个月（8 - 119个月）。多因素分析显示，既往干预（OR 1.44；CI 1.15 - 1.79；p = 0.01）、术后并发症（OR 2.57；CI 1.09 - 6.03；p = 0.03）和Clavien - Dindo评分>2（OR 1.43；CI 1.031 - 1.876；p = 0.02）是复发的独立预后因素。轻微并发症与14.7%的复发相关，严重并发症与30%的复发相关。急诊LVHR（6%）并未增加并发症发生率。总体血清肿发生率为18.7%，持续性或复杂性血清肿发生率为1.4%。BMI（OR 1.05；CI 1.01 - 1.08；p = 0.026）和血管手术史（OR 5.74；CI 2.11 - 15.58；p < 0.001）是血清肿的独立预测因素。复发似乎与血清肿无关。
LVHR兼具腹腔镜手术和补片修补的优点。血清肿形成不应再被视为一种并发症。在大多数情况下，它会自行消退。术后并发症及其严重程度似乎是复发的独立预后因素，采用标准化技术可减少复发，这可能使IPOM - LVHR成为一种参考术式。
