Hernia Center, Hospital Alemão Oswaldo Cruz, R. Treze de Maio, 1815, 01327-001, São Paulo, SP, Brazil.
Abdominal Wall Surgery Group, Department of Surgery, Irmandade da Santa Casa de Misericórdia de São Paulo, R. Dr. Cesário Mota Júnior, 112., 01221-020, São Paulo, SP, Brazil.
Hernia. 2019 Feb;23(1):157-165. doi: 10.1007/s10029-019-01880-5. Epub 2019 Jan 30.
A residual bulge in the lateral abdominal wall is a reason for patient dissatisfaction after flank hernia repair (FHR). We hypothesized that combining a laparoscopically-placed intraperitoneal mesh (IPOM) with onlay hernia repair performed through a small open incision would increase repair durability and decrease such residual bulges. We aim to report our medium-term outcomes with this technique.
Patients who have undergone FHR using the technique described above from March 2013 through June 2017 were identified in a prospectively maintained database. Outcomes of interest included surgical site infections (SSI), surgical site occurrences (SSO), surgical site occurrences requiring procedural intervention (SSOPI) and hernia recurrence.
Sixteen patients were identified (62% females; mean age 59 ± 8 years, mean body mass index 29.5 kg/m). Mean hernia width was. 6.4 ± 3 cm and 31% were recurrent hernias previously repaired through an onlay approach. Mean operative time was 159 ± 40 min, fascial closure was achieved in all cases, and there were no intraoperative complications. Median length of stay was 3 days (IQR 3-4), and there were no unplanned readmissions or reoperations. At a median 37-month follow-up (IQR 21-55), wound morbidity rate was 12.5% (2 seromas). There were no SSI/SSOPI and one hernia recurrence (6%) was detected at 12 months postoperatively.
Combining laparoscopic IPOM with open onlay hernia repair resulted in low recurrence and acceptable wound morbidity rates, with no residual bulges noted at medium-term follow-up. Further studies with larger number of patients and other surgeon's experiences are necessary to determine the role of such technique in the surgical armamentarium for flank hernia repair.
侧腹壁的残余膨出是腰疝修补（FHR）后患者不满意的原因。我们假设，将腹腔镜下放置的腹腔内补片（IPOM）与通过小切口进行的外侧疝修补相结合，将增加修复的耐久性，并减少这种残余膨出。我们旨在报告使用该技术的中期结果。
从 2013 年 3 月至 2017 年 6 月，通过前瞻性维护的数据库确定使用上述技术进行 FHR 的患者。感兴趣的结果包括手术部位感染（SSI）、手术部位事件（SSO）、需要手术干预的手术部位事件（SSOPI）和疝复发。
确定了 16 名患者（62%为女性；平均年龄 59 ± 8 岁，平均体重指数 29.5 kg/m）。平均疝宽度为 6.4 ± 3 cm，31%为先前通过外侧入路修补的复发性疝。平均手术时间为 159 ± 40 分钟，所有病例均实现筋膜闭合，无术中并发症。中位住院时间为 3 天（IQR 3-4），无计划再入院或再手术。在中位数为 37 个月的随访中（IQR 21-55），伤口发病率为 12.5%（2 例血清肿）。无 SSI/SSOPI，1 例疝复发（6%）于术后 12 个月发现。
腹腔镜 IPOM 与外侧疝修补术相结合，复发率低，伤口发病率可接受，在中期随访中未发现残余膨出。需要进行更多患者和其他外科医生经验的进一步研究，以确定该技术在腰疝修复手术中的作用。
