Department of General Surgery, Sulaiman Medical Group, Al Takhassusi General Hospital, P.O. Box: 2000, Riyadh, 11393, Kingdom of Saudi Arabia.
Department of General and Digestive Surgery, La Mancha-Centro General Hospital, 13600, Alcázar de San Juan, Ciudad Real, Spain.
Surg Endosc. 2017 Nov;31(11):4514-4521. doi: 10.1007/s00464-017-5510-4. Epub 2017 Apr 3.
It is not yet clearly known whether laparoscopic ventral hernia repair (LVHR) is superior to the open approach in recurrent hernias. The aim of this study is to determine the safety and efficacy of laparoscopic technique for ventral hernias and investigate whether these outcomes are affected by the number of previous failed repairs.
Data from 124 consecutive patients who underwent LVHR using a standardized technique between September 2007 and June 2014 were collected prospectively. In all repairs, a composite prosthesis was tailored to overlap the defect by at least 5 cm and fixed with a double crown of spiral tacks. Clinical follow-up visits were performed at 1 week, 1, 6, and 12 months, and yearly thereafter. Patients were classified in 3 groups (0, 1, and ≥ 2) according to the number of previous hernia repairs for further statistical analysis.
Long-term surveillance was available in 116 (93%) patients. Of these, 96 (82.8%) were recurrent hernias. There were 2 (1.7%) conversions, both in recurrent cases, and in 3 (2.6%) patients a hybrid access was used. Mean operating time was 55 min. There was an overall postoperative complication rate of 16%, with no mortality. During a mean follow-up of 30 (range 20-90) months, 3 (2.6%) recurrences were diagnosed 6, 8, and 9 months after surgery, respectively. A univariate analysis related to demographic, clinical, and perioperative variables did not find any significant relationship between the number of previous recurrences and operating time, conversion rate, hospital length of stay, overall morbidity, or recurrence.
This study suggests that laparoscopic approach in recurrent incisional hernias is a safe and feasible alternative to open techniques. Furthermore, our experience supports the idea that LVHR may be the best option for recurrent cases in properly selected patients, independently of the number of previous recurrences.
腹腔镜腹疝修补术（LVHR）是否优于开放式手术治疗复发性疝目前尚不清楚。本研究旨在确定腹腔镜技术治疗腹疝的安全性和有效性，并探讨这些结果是否受先前失败修复次数的影响。
收集 2007 年 9 月至 2014 年 6 月期间采用标准化技术行 LVHR 的 124 例连续患者的前瞻性数据。在所有修复中，复合补片剪裁为至少重叠缺损 5cm，并使用螺旋钉双重冠状固定。临床随访在术后 1 周、1、6 和 12 个月以及此后每年进行。根据先前疝修复的次数将患者分为 3 组（0、1 和≥2）进行进一步统计分析。
116 例（93%）患者获得长期随访。其中，96 例（82.8%）为复发性疝。有 2 例（1.7%）发生转换，均为复发性疝，3 例（2.6%）采用混合入路。平均手术时间为 55 分钟。总术后并发症发生率为 16%，无死亡病例。在平均 30（范围 20-90）个月的随访中，分别在术后 6、8 和 9 个月诊断出 3 例（2.6%）复发。单变量分析与人口统计学、临床和围手术期变量相关，未发现先前复发次数与手术时间、转换率、住院时间、总发病率或复发之间存在任何显著关系。
本研究表明，腹腔镜方法治疗复发性切口疝是一种安全可行的开放式手术替代方法。此外，我们的经验支持这样一种观点，即在适当选择的患者中，LVHR 可能是复发性病例的最佳选择，与先前复发次数无关。
