Macquarie University Hospital, Technology Place, Macquarie, Australia.
Hernia Institute Australia, Edgecliff, Australia.
Surg Endosc. 2018 May;32(5):2474-2479. doi: 10.1007/s00464-017-5949-3. Epub 2017 Dec 20.
Component separation (CS) is a technique which mobilizes flaps of innervated, vascularized tissue, enabling closure of large ventral hernia defects using autologous tissue. Disadvantages include extensive tissue dissection when creating these myofascial advancement flaps, with potential consequences of significant post-operative skin and wound complications. This study examines the benefit of a novel, ultra-minimally invasive single port anterior CS technique.
This was a prospective study of 16 external oblique (EO) releases performed in 9 patients and 4 releases performed in 3 fresh frozen cadavers. All patients presented with recurrent complex ventral hernias, and were administered preoperative Botulinum Toxin A to their lateral oblique muscles to facilitate defect closure. At the time of elective laparoscopic repair, patients underwent single port endoscopic EO release using a single 20-mm incision on each side of the abdomen. Measurements were taken using real-time ultrasound. Postoperatively, patients underwent serial examination and abdominal CT assessment.
Single port endoscopic EO release achieved a maximum of 50-mm myofascial advancement per side (measured at the umbilicus). No complications involving wound infection, hematoma, or laxity/bulge have been noted. All patients proceeded to laparoscopic or laparoscopic-open-laparoscopic intraperitoneal mesh repair of their hernia, with no hernia recurrences to date.
Single port endoscopic EO release holds potential as an adjunct in the repair of large ventral hernia defects. It is easy to perform, is safe and efficient, and entails minimal disruption of tissue planes and preserves abdominal wall perforating vessels. It requires only one port-sized incision on each side of the abdomen, thus minimizing potential for complications. Further detailed quantification of advancement gains and morbidity from this technique is warranted, both with and without prior administration of Botulinum Toxin A to facilitate closure.
组件分离（CS）是一种技术，它可以动员有神经支配和血管化的组织瓣，使用自体组织来闭合大的腹侧疝缺损。缺点包括在创建这些肌肉筋膜推进瓣时需要广泛的组织解剖，可能导致术后皮肤和伤口并发症显著。本研究检查了一种新的、微创单端口前 CS 技术的益处。
这是一项前瞻性研究，共纳入 9 例患者的 16 次外斜肌（EO）松解术和 3 例新鲜冷冻尸体的 4 次松解术。所有患者均表现为复发性复杂腹侧疝，并在手术前接受了肉毒毒素 A 注射以促进缺损闭合。在选择性腹腔镜修复时，患者在腹部两侧进行单端口内镜 EO 松解，每个切口为 20mm。使用实时超声进行测量。术后，患者接受了系列检查和腹部 CT 评估。
单端口内镜 EO 松解术每侧可获得最大 50mm 的筋膜推进（在脐部测量）。没有出现伤口感染、血肿或松弛/膨出等并发症。所有患者均行腹腔镜或腹腔镜-开放式腹腔镜腹腔内网片修补术，至今无疝复发。
单端口内镜 EO 松解术在修复大的腹侧疝缺损方面具有潜力。它易于操作，安全有效，对组织平面的干扰最小，并保留了腹壁穿支血管。它只需要在腹部两侧各做一个端口大小的切口，从而最大限度地减少潜在的并发症。需要进一步详细量化该技术的进展收益和发病率，包括是否在手术前使用肉毒毒素 A 来促进闭合。
