Suwa Katsuhito, Okamoto Tomoyoshi, Yanaga Katsuhiko
Department of Surgery, The Jikei University Daisan Hospital, Tokyo, Japan.
Department of Surgery, The Jikei University, Tokyo, Japan.
Asian J Endosc Surg. 2018 Nov;11(4):378-384. doi: 10.1111/ases.12471. Epub 2018 Mar 23.
The ideal surgical technique for large incisional hernia repair has not yet been identified. The aim of this study was to evaluate surgical outcomes of standard intraperitoneal onlay mesh (sIPOM) versus fascial defect closure with intraperitoneal onlay mesh (IPOM-Plus) for large incisional hernia repair.
Of 49 patients who underwent laparoscopic incisional hernia repair between November 2005 and December 2016, 26 cases with large incisional hernia (transverse diameter ≥10 cm) were examined to compare surgical outcomes between sIPOM (n = 12) and IPOM-Plus (n = 14). Statistical analysis was performed using the Mann-Whitney U-test and Fisher's exact test. P < 0.05 was considered to be statistically significant.
We compared sIPOM with IPOM-Plus for similar hernia types during median follow-up periods of 53 and 21 months, respectively. The operation time was 150 min for sIPOM and 148 min for IPOM-Plus (P = 0.6220). Early postoperative complications including seroma formation were observed in four sIPOM patients (33%) and three IPOM-Plus patients (21%) (P = 0.6652). Significantly more mesh bulged with sIPOM than with IPOM-Plus (50% vs 0%; P = 0.0082). Chronic pain lasting 3 months after the operation was found in two cases of IPOM-Plus (14%), but this was not statistically significant. Postoperative hospital stay was longer for sIPOM patients than for IPOM-Plus patients. Only one recurrence was observed in the sIPOM group (8%), but this was not statistically significant.
For large incisional hernia repair, IPOM-Plus seems to be more effective than sIPOM in terms of reducing mesh bulging.
大型切口疝修补的理想手术技术尚未确定。本研究的目的是评估标准腹腔内补片植入术（sIPOM）与腹膜内补片植入联合筋膜缺损闭合术（IPOM-Plus）用于大型切口疝修补的手术效果。
在2005年11月至2016年12月期间接受腹腔镜切口疝修补术的49例患者中，对26例大型切口疝（横径≥10 cm）患者进行检查，以比较sIPOM组（n = 12）和IPOM-Plus组（n = 14）的手术效果。采用Mann-Whitney U检验和Fisher精确检验进行统计分析。P < 0.05被认为具有统计学意义。
我们分别在中位随访期53个月和21个月时，对sIPOM组和IPOM-Plus组的相似疝类型进行了比较。sIPOM组的手术时间为150分钟，IPOM-Plus组为148分钟（P = 0.6220）。4例sIPOM患者（33%）和3例IPOM-Plus患者（21%）出现了包括血清肿形成在内的早期术后并发症（P = 0.6652）。sIPOM组补片突出明显多于IPOM-Plus组（50% 对0%；P = 0.0082）。IPOM-Plus组有2例（14%）患者术后出现持续3个月的慢性疼痛，但无统计学意义。sIPOM组患者的术后住院时间长于IPOM-Plus组患者。sIPOM组仅观察到1例复发（8%），但无统计学意义。
对于大型切口疝修补，IPOM-Plus在减少补片突出方面似乎比sIPOM更有效。
