van Schalkwyk Constant P, Dusseldorp Joseph R, Liang Derek G, Keshava Anil, Gilmore Andrew J, Merten Steve
Department of Plastic and Reconstructive Surgery, Concord Repatriation General Hospital, Concord, NSW, Australia.
Department of General Surgery, Macquarie University Hospital, North Ryde, NSW, Australia.
Aesthet Surg J. 2018 Nov 12;38(12):NP196-NP204. doi: 10.1093/asj/sjy100.
Umbilical hernia is a common finding in patients undergoing abdominoplasty, especially those who are postpartum with rectus divarication. Concurrent surgical treatment of the umbilical hernia at abdominoplasty presents a "vascular challenge" due to the disruption of dermal blood supply to the umbilicus, leaving the stalk as the sole axis of perfusion. To date, there have been no surgical techniques described to adequately address large umbilical herniae during abdominoplasty.
To present an effective and safe technique that can address large umbilical herniae during abdominoplasty.
A prospective series of 10 consecutive patients, undergoing concurrent abdominoplasty and laparoscopic umbilical hernia repair between 2014 and 2017 were included in the study. All procedures were performed by the same general surgeon and plastic surgeon at the Macquarie University Hospital in North Ryde, NSW, Australia. Data were collected with approval of our ethics committee.
At 12-month follow up there were no instances of umbilical necrosis, wound complications, seroma, or recurrent hernia. The mean body mass index was 23.8 kg/m2 (range, 16.1-30.1 kg/m2). Rectus divarication ranged from 35 to 80 mm (mean, 53.5 mm). Umbilical hernia repair took a mean of 25.9 minutes to complete (range, 18-35 minutes).
We present a technique that avoids incision of the rectus fascia minimizes dissection of the umbilical stalk and is able to provide a gold standard hernia repair with mesh. This procedure is particularly suited to postpartum patients with large herniae (>3-4 cm diameter) and wide rectus divarication, where mesh repair with adequate overlap is the recommended treatment.
脐疝是接受腹壁成形术患者的常见表现，尤其是那些产后伴有腹直肌分离的患者。在腹壁成形术中同时进行脐疝手术治疗时，由于脐部皮肤血液供应中断，会带来“血管挑战”，致使脐蒂成为唯一的灌注轴。迄今为止，尚无描述在腹壁成形术中充分处理大型脐疝的手术技术。
介绍一种在腹壁成形术中处理大型脐疝的有效且安全的技术。
本研究纳入了2014年至2017年间连续10例同时接受腹壁成形术和腹腔镜脐疝修补术的患者。所有手术均由澳大利亚新南威尔士州北莱德麦考瑞大学医院的同一位普通外科医生和整形外科医生进行。数据收集经我们的伦理委员会批准。
在12个月的随访中，未出现脐坏死、伤口并发症、血清肿或复发性疝的情况。平均体重指数为23.8kg/m²（范围为16.1 - 30.1kg/m²）。腹直肌分离范围为35至80mm（平均53.5mm）。脐疝修补平均耗时25.9分钟（范围为18 - 35分钟）。
我们介绍的这项技术避免了切开腹直肌筋膜，尽量减少脐蒂的解剖，并能够使用补片提供金标准的疝修补。该手术特别适用于患有大型疝（直径>3 - 4cm）和宽腹直肌分离的产后患者，对于此类患者，推荐采用具有足够重叠的补片修补治疗。
