Prete Francesco Paolo, Gurrado Angela, Pasculli Alessandro, Sgaramella Lucia Ilaria, Catalano Giovanni, Sallustio Pierluca Nicola Massimo, Carbotta Giuseppe, Ialongo Paolo, Cavallaro Giuseppe, Testini Mario
Academic General Surgery Unit "V. Bonomo", Department of Biomedical Sciences and Human Oncology, University Medical School of Bari, Bari, Italy.
Department of Surgery "P. Valdoni", University of Rome "La Sapienza", Rome, Italy.
Surg Technol Int. 2020 May 28;36:124-130.
To investigate the safety and outcomes of laparoscopic control of intraperitoneal mesh positioning in open umbilical hernia repair.
This study is a retrospective review of a series of adult patients with uncomplicated umbilical hernia who underwent elective open repair with a self-expanding patch with laparoscopic control from March 2011 to December 2018. The adequacy of mesh positioning was inspected with a 5-mm 30° scope in the left flank. The primary endpoint was recurrence. Secondary endpoints were rate of mesh repositioning, intraoperative complications and time, length of stay and postoperative pain.
Thirty-five patients underwent open inlay repair of primary umbilical hernia with laparoscopic control. Six patients (17.1%) were obese. The mean operating time was 63.3 min. The mean defect size was 2.6 cm (0.6-5) and the mean mesh overlap was 3.2cm (2.2-4.5). There were no intraoperative complications. Laparoscopic control required mesh repositioning in 5 cases (14.3%). The median length of stay was 2 days. Perioperative complications were recorded in three cases (8.6%): one seroma and two serous wound discharge (Clavien-Dindo I). The recurrence rate was 2.9% (1 case) at a median follow-up of 60 months. BMI>30 was associated with a higher rate of intraoperative mesh repositioning (p=0.001). Non-reabsorbable mesh and COPD were associated with a higher incidence of postoperative complications (p=0.043). Postoperative pain scores were consistently at mild levels, with no statistically significant differences between patients who had their mesh repositioned and those who had not.
Laparoscopic control of mesh positioning is a safe addition to open inlay umbilical hernia repair and enables the accurate verification of correct mesh deployment with low complication and recurrence rates.
探讨在开放脐疝修补术中采用腹腔镜控制腹腔内补片放置的安全性及效果。
本研究回顾性分析了2011年3月至2018年12月期间一系列接受择期开放修补术且使用自膨式补片并通过腹腔镜控制的单纯性脐疝成年患者。通过左侧腹部一个5毫米的30°腹腔镜检查补片放置是否合适。主要终点是复发情况。次要终点包括补片重新放置率、术中并发症及时间、住院时间和术后疼痛。
35例患者接受了腹腔镜控制下的原发性脐疝开放嵌入修补术。6例患者（17.1%）为肥胖患者。平均手术时间为63.3分钟。平均缺损大小为2.6厘米（0.6 - 5厘米），平均补片重叠为3.2厘米（2.2 - 4.5厘米）。无术中并发症。腹腔镜控制下有5例（14.3%）需要重新放置补片。中位住院时间为2天。围手术期并发症记录在3例（8.6%）：1例血清肿和2例伤口浆液性渗出（Clavien-Dindo I级）。中位随访60个月时复发率为2.9%（1例）。BMI>30与术中补片重新放置率较高相关（p = 0.001）。不可吸收补片和慢性阻塞性肺疾病与术后并发症发生率较高相关（p = 0.043）。术后疼痛评分始终处于轻度水平，补片重新放置患者与未重新放置患者之间无统计学显著差异。
腹腔镜控制补片放置是开放嵌入脐疝修补术的一种安全辅助手段，能准确验证补片放置正确，并发症和复发率低。
