Department of General Surgery, Affiliated Hexian Memorial Hospital of Southern Medical University, Guangzhou, 511400, China.
Department of Hernia and Abdominal Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China.
Surg Endosc. 2020 Apr;34(4):1543-1550. doi: 10.1007/s00464-018-6568-3. Epub 2018 Oct 29.
The Rives-Stoppa procedure is used for ventral hernia repair but requires a large midline incision. This report describes a new, totally endoscopic approach to the retromuscular plane, corresponding to a reversed totally extraperitoneal procedure, to perform sublay repair of primary and secondary ventral hernias. This totally endoscopic sublay (TES) repair is described in detail, and its safety and efficacy were evaluated.
In this prospective study, we assessed 26 consecutive primary and secondary epigastric midline ventral hernias that were repaired between July 2017 and July 2018 using the TES procedure. A large mesh was placed in the retrorectus position using this minimally invasive approach. Indications for this procedure include umbilical, epigastric, incisional hernias, and rectus diastasis.
All TES procedures were successfully performed without conversion to an open operation. The mean operative time was 106.6 ± 29.1 min (range 75-205), with average mesh area of 318.8 cm for an average defect area of 26.5 cm. Postoperative pain was mild, and the mean visual analog scale (VAS) under physical stress (e.g., climbing stairs) was 2.4 at the third postoperative day. The average postoperative hospital stay was 2.8 ± 0.8 days (range 2-5). Two patients developed postoperative seroma, with no final adverse effect. No recurrence nor readmissions within 30 days was observed during a mean follow-up of 9.2 ± 4.4 months.
Initial experiences with this technique show that the TES procedure is safe and reliable, requires no specific instruments, and is highly reproducible. There is no need for an expensive anti-adhesion mesh or fixation device, making it cost-effective.
Rives-Stoppa 手术用于治疗腹疝，但需要一个大的中线切口。本报告描述了一种新的、完全内镜的后肌平面入路，对应于一种反向完全腹膜外手术，用于进行原发性和继发性腹疝的下修补。详细描述了这种完全内镜下下修补术（TES），并评估了其安全性和有效性。
在这项前瞻性研究中，我们评估了 2017 年 7 月至 2018 年 7 月期间使用 TES 手术治疗的 26 例连续原发性和继发性上腹部中线腹疝。使用这种微创方法将一个大网片置于后直肠位置。该手术的适应证包括脐疝、上腹部疝、切口疝和腹直肌分离。
所有 TES 手术均成功完成，无中转开放手术。平均手术时间为 106.6±29.1 分钟（范围 75-205 分钟），平均网片面积为 318.8cm，平均缺损面积为 26.5cm。术后疼痛轻微，术后第 3 天在体力应激下（如爬楼梯）平均视觉模拟评分（VAS）为 2.4。平均术后住院时间为 2.8±0.8 天（范围 2-5 天）。2 例患者术后出现血清肿，但无最终不良影响。在平均 9.2±4.4 个月的随访中，未观察到 30 天内复发或再次入院。
该技术的初步经验表明，TES 手术是安全可靠的，不需要特殊器械，且具有高度可重复性。不需要昂贵的防粘连网片或固定装置，具有成本效益。
