Schwab Robert, Sahm Joachim, Willms Arnulf Gregor
Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital, Koblenz, Germany.
Front Surg. 2018 Apr 4;5:29. doi: 10.3389/fsurg.2018.00029. eCollection 2018.
The purpose is to present a new hybrid approach of lateral incisional hernia repair associated with reduced operative trauma and anatomically optimal mesh placement.
Video-Assisted Mini-Open Sublay (VAMOS) consists of a laparoscopic atraumatic dissection of the hernia sac, diaphanoscopy, laparoscopically-assisted closure of the fascial gap and mesh placement in sublay position through a minimized skin incision. Feasibility of this concept was assessed in a cohort of 7 consecutive patients.
VAMOS approach was feasible in all 7 patients. Median hernia size was 8 cm, the median skin incision width was 7.7 cm. Median operative time was 86 min. In all patients a sufficient mesh overlap on all sides of the fascial gap was ensured. On short-term follow-up no procedure related complications were recorded, seroma formation occurred in 2 patients. Pain medication was necessary for median 4.9 days. There was no need for pain medication on day 14, whatsoever.
Initial VAMOS results show that the technique is simple, time-saving and safe. It provides a substantial reduction in postoperative pain compared to an open approach. Through implantation in the intermuscular sublay position and minor access-related trauma, it is possible to achieve a biomechanically optimal mesh position, to lay the foundations for adequate remodelling of the abdominal wall, and to prevent recurrence as well as local complications. All in all, VAMOS appears to have several advantages over current surgical strategies.
介绍一种新的外侧切口疝修补混合方法，该方法可减少手术创伤并实现解剖学上最佳的补片放置。
视频辅助迷你开放肌下修补术（VAMOS）包括对疝囊进行腹腔镜下无创伤解剖、透光检查、腹腔镜辅助关闭筋膜间隙以及通过最小化皮肤切口在肌下位置放置补片。在连续7例患者的队列中评估了该概念的可行性。
VAMOS方法在所有7例患者中均可行。疝的中位大小为8厘米，皮肤切口的中位宽度为7.7厘米。中位手术时间为86分钟。在所有患者中，均确保了补片在筋膜间隙各侧有足够的重叠。短期随访未记录到与手术相关的并发症，2例患者出现了血清肿形成。中位4.9天需要使用止痛药物。在第14天，完全不需要止痛药物。
VAMOS的初步结果表明，该技术简单、省时且安全。与开放手术相比，它能显著减轻术后疼痛。通过植入肌间肌下位置并减少与手术入路相关的创伤，可以实现生物力学上最佳的补片位置，为腹壁的充分重塑奠定基础，并预防复发以及局部并发症。总体而言，VAMOS似乎比当前的手术策略具有多个优势。
