Raakow J, Schulte-Mäter J, Callister Y, Aydin M, Denecke C, Pratschke J, Kilian M
Department of Surgery, Charité Campus Mitte, Campus Virchow Klinikum, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Hernia. 2018 Dec;22(6):1083-1088. doi: 10.1007/s10029-018-1815-z. Epub 2018 Aug 29.
Incisional hernias to the subxiphoid region are rare and anatomically challenging, with bony and cartilaginous structures attaching, as well as conflating abdominal fascia. The repair of hernias in this region is, therefore, difficult and prone to recurrence. The surgical treatment can be done by open or laparoscopic repair but very little is known about which method is superior. We, therefore, reviewed our data of patients undergoing repair of subxiphoid hernias.
Between January 2010 and June 2015 twenty-eight patients were treated by laparoscopic (n = 8) or open (n = 20) hernia repair due to an incisional hernia in the subxiphoid region. Patients with ventral hernias with an origin more distal than the M1-area only extending into the subxiphoid region and those undergoing suture hernia repair were excluded.
The hernia sizes, in terms of length, width and EHS classification, did not vary between open and laparoscopic repair. The duration of laparoscopic surgery was significantly shorter than the mean operative time for an open subxiphoid hernia repair (168.1 min vs. 96.1 min, respectively; p = 0.012). The groups did not differ significantly in terms of overall postoperative complications (p = 0.568) but the grade (Clavien-Dindo) of complications was higher following open repair leading to three reoperations. Within the follow-up time, we diagnosed significantly (p = 0.031) more subxiphoid hernia recurrences after laparoscopic repair (37.5%, n = 3) than after open repair (0%).
Laparoscopic and open repair of subxiphoid incisional hernias are both technically challenging compared to other midline hernias. Referring to our results laparoscopic repair has shorter operative times, lower postoperative morbidity with a higher recurrence rate compared to open repair but the sample size is too small for an overall conclusion.
剑突下区域的切口疝较为罕见，且在解剖结构上具有挑战性，该区域有骨骼和软骨结构附着，同时腹部筋膜相互交织。因此，该区域疝的修复困难且易于复发。手术治疗可通过开放或腹腔镜修复进行，但对于哪种方法更具优势知之甚少。因此，我们回顾了接受剑突下疝修补术患者的数据。
2010年1月至2015年6月期间，28例因剑突下区域切口疝接受腹腔镜（n = 8）或开放（n = 20）疝修补术的患者。仅延伸至剑突下区域且起源比M1区域更远端的腹疝患者以及接受缝合疝修补术的患者被排除。
就长度、宽度和欧洲疝学会（EHS）分类而言，开放修补和腹腔镜修补之间的疝大小没有差异。腹腔镜手术的持续时间明显短于开放剑突下疝修补术的平均手术时间（分别为168.1分钟和96.1分钟；p = 0.012）。两组在总体术后并发症方面没有显著差异（p = 0.568），但开放修补术后并发症的分级（Clavien-Dindo）更高，导致3例再次手术。在随访期间，我们诊断出腹腔镜修补术后剑突下疝复发（37.5%，n = 3）明显多于开放修补术后（0%）（p = 0.031）。
与其他中线疝相比，剑突下切口疝的腹腔镜和开放修补在技术上都具有挑战性。根据我们的结果，腹腔镜修补术的手术时间较短，术后发病率较低，但与开放修补相比复发率较高，不过样本量太小，无法得出总体结论。
