Köhler Gernot, Fischer Ines, Kaltenböck Richard, Schrittwieser Rudolf
1 Department of General and Visceral Surgery, Congregation Hospital (Sisters of Charity) , Linz, Austria .
2 Department of Surgery, Paracelsus Medical University , Salzburg, Austria .
J Laparoendosc Adv Surg Tech A. 2018 Oct;28(10):1223-1228. doi: 10.1089/lap.2018.0018. Epub 2018 Apr 5.
Patients with umbilical or epigastric hernias benefit from mesh- based repairs, and even more so if a concomitant rectus diastasis (RD) is present. The ideal technique is, however, still under debate. In this study we introduce the minimal invasive linea alba reconstruction (MILAR) with the supraaponeurotic placement of a fully absorbable synthetic mesh.
Midline reconstruction with anterior rectus sheath repair and mesh augmentation by an open approach is a well-known surgical technique for ventral hernia repair. Between December 1, 2016, and November 30, 2017, 20 patients with symptomatic umbilical and/or epigastric hernias, and coexisting RD underwent a minimally invasive complete reconstruction of the midline through a small access route. The inner part of both incised and medialized anterior rectus sheaths was replaced by a fully absorbable synthetic mesh placed in a supraaponeurotic position.
Patients were hospitalized for an average of 4 days and the mean operating time was 79 minutes. The mean hernia defect size was 1.5 cm in diameter and the mean mesh size was recorded as 15.8 cm in length and 5.2 cm in width. Two patients sustained surgical postoperative complications in terms of symptomatic seroma occurrences with successful interventional treatment.The early results (mean follow-up period of 5 months) showed no recurrences and only 1 patient reported occasional pain following exertion without rest.
MILAR is a modification of the recently published endoscopic linea alba reconstruction restoring the normal anatomy of the abdominal wall. A new linea alba is formed with augmentation of autologous tissue consisting of the plicated anterior rectus sheaths. Supraaponeurotic placement of a fully absorbable synthetic mesh eliminates potential long-term mesh-associated complications. Regarding MILAR, there is no need for endoscopic equipment due to the uniquely designed flexible lighted retractors, meaning one assistant less is required.
脐疝或上腹疝患者可从基于补片的修补术中获益，若同时存在腹直肌分离（RD），获益则更多。然而，理想的技术仍存在争议。在本研究中，我们介绍了一种微创白线重建术（MILAR），即在上腹直肌后鞘位置放置完全可吸收的合成补片。
通过开放手术进行腹直肌前鞘修补及补片加强的中线重建术是一种众所周知的腹侧疝修补手术技术。在2016年12月1日至2017年11月30日期间，20例有症状的脐疝和/或上腹疝且并存RD的患者通过小切口入路接受了微创中线完全重建术。切开并向内侧移位的腹直肌前鞘的内侧部分被置于上腹直肌后鞘位置的完全可吸收合成补片所替代。
患者平均住院4天，平均手术时间为79分钟。平均疝缺损直径为1.5厘米，平均补片尺寸记录为长15.8厘米、宽5.2厘米。两名患者术后出现有症状的血清肿这一手术并发症，经介入治疗成功。早期结果（平均随访期5个月）显示无复发，仅有1例患者报告在无休息的用力后偶尔疼痛。
MILAR是对最近发表的内镜白线重建术的一种改良，可恢复腹壁的正常解剖结构。通过折叠的腹直肌前鞘形成自体组织加强，从而形成新的白线。在上腹直肌后鞘位置放置完全可吸收的合成补片可消除潜在的与补片相关的长期并发症。对于MILAR，由于独特设计的柔性照明牵开器，无需内镜设备，这意味着少需要一名助手。
