Life Memorial Hospital, Bucharest, Romania.
Hernia. 2019 Oct;23(5):945-955. doi: 10.1007/s10029-019-01931-x. Epub 2019 Mar 28.
The aim of this article is to describe the technique and early follow-up results of abdominal wall reconstruction (AWR) by minimally invasive surgery (MIS); it concerns the already described endoscopic (retromuscular) Rives procedure (e-Rives) and posterior component separation with transversus abdominis release (TAR) by endoscopic approach (eTEP-TAR).
This is a prospective study which consists of 60 patients operated on between May 2016 and December 2017 by a single surgeon and monitored until July 2018. This is a heterogenic cohort with different hernia types (lateral, median, combined) which were also treated with different meshes. This material includes physiological and biomechanical issues related to the abdominal wall, the key stages of the operation including port placement strategy.
The group of patients are 55% male, having a mean age of 53.3 years old, mean BMI of 29.3 and median ASA score of 1.83. The majority of the hernia types is represented by incisional hernia (61.7%) located especially on the median side of the abdomen (80%); more than half of them (60%) are reducible. There were 6 (10%) intraoperative complications that lead to four conversions to open or traditional laparoscopic techniques. Postoperative re-admission-two cases: one case with small bowel obstruction, solved by laparoscopic surgery and one case with hemorrhagic gastritis because of non-steroidal anti-inflammatory treatment that required only medical treatment. Quality of life (assessed on a 0-10 scale) evaluating the postoperative pain, normal activity and aesthetics, shows a significant improvement after 2 weeks and 3 months postoperatively compared to the preoperative level. 93.3% of the patients have been monitored and no recurrences after a mean of 15 months have been reported.
A thorough understanding of the anatomy and surgical technique is mandatory. The eTEP approach is a feasible and safe option in MIS ventral hernia repair.
本文旨在描述微创外科（MIS）下腹壁重建（AWR）的技术和早期随访结果；它涉及已经描述的内镜（肌后）Rives 手术（e-Rives）和经内镜入路的腹横肌释放后部分分离（eTEP-TAR）。
这是一项前瞻性研究，共纳入 60 例患者，由同一位外科医生于 2016 年 5 月至 2017 年 12 月间进行手术，并随访至 2018 年 7 月。这是一个异质队列，有不同类型的疝（外侧、正中、复合），也使用不同的补片进行治疗。该材料包括与腹壁相关的生理和生物力学问题、手术的关键阶段，包括端口放置策略。
患者组中男性占 55%，平均年龄为 53.3 岁，平均 BMI 为 29.3，ASA 评分中位数为 1.83。疝的主要类型是切口疝（61.7%），位于腹部正中（80%）；其中超过一半（60%）可复性。有 6 例（10%）术中并发症导致 4 例转为开放或传统腹腔镜技术。术后再次入院 2 例：1 例因小肠梗阻，行腹腔镜手术解决；1 例因非甾体抗炎治疗导致出血性胃炎，仅需药物治疗。生活质量（以 0-10 分评估）评估术后疼痛、正常活动和美观度，与术前相比，术后 2 周和 3 个月有显著改善。93.3%的患者得到了监测，平均 15 个月后无复发报告。
对解剖和手术技术有透彻的了解是必要的。eTEP 方法是 MIS 腹疝修补的一种可行且安全的选择。
