Institut de La Hernie, 15 Rue du Cirque, 75008, Paris, France.
Polyclinique de La Manche, 45 Boulevard Général Koenig, 50000, Saint-Lô, France.
Surg Endosc. 2021 Mar;35(3):1370-1377. doi: 10.1007/s00464-020-07519-2. Epub 2020 Apr 2.
The repair of ventral hernias by intra-peritoneal patch (IPOM) involves a risk of pain due to stapling as well as intestinal adhesions. Extraperitoneal placement of the patch without fixation can prevent these drawbacks. Techniques of endoscopic preperitoneal repair were previously described by others. The aim of this article is to describe our technique and to evaluate the feasibility and short-term results.
The totally endoscopic technique consists of dividing the median aponeurotic structures, while preserving the proper linea alba, to create a unique retro-muscular space, in which the patch is deployed without any fixation. Hundred twelve consecutive patients were operated on for ventral hernias (82 umbilical, 20 epigastric, 10 combined). Perioperative data including duration of operation, technical problems, conversions and complications, as well as postoperative pain, time to resume daily activities and time off work were prospectively assessed.
98 (87.5%) patients were operated in ambulatory surgery, and 14 (12.5%) in overnight stay. The mean sizes of the hernia and the patch were 9 (1-50) cm and 225 (50-500) cm, respectively. The mean operation duration was 75 (30-270) min. The peritoneum was opened in 43 (38.4%) cases and closed by suture in 41 instances. There were 5 (4.5%) conversions to IPOM and 4 (3.6%) complications (1 seroma, 1 urine retention, 1 transitory ileus, and 1 intestinal obstruction) which were reoperated. The mean VAS value of postoperative pain was 2.45 (0-8), pain was scored 0 by 17 (15%) patients. The mean times to resume daily activity and work were 4 (1-15) days and 11.5 (1-30) days, respectively.
Our results suggest that VTEP is safely feasible by surgeons skilled in laparoscopy, and might contribute to minimize pain, though this must be established by comparative studies.
经腹腔内补片修补术（IPOM）修复腹疝会因钉合导致疼痛，并伴有肠粘连。不固定地将补片置于腹膜外可以预防这些缺点。其他作者之前已经描述了经内镜腹膜前修补技术。本文的目的是描述我们的技术，并评估其可行性和短期结果。
完全内镜技术包括分离中线腱膜结构，同时保留适当的白线，以创建一个独特的肌后空间，其中无需任何固定即可放置补片。112 例连续腹疝患者（82 例脐疝、20 例上腹部疝、10 例复合疝）接受了手术。前瞻性评估围手术期数据，包括手术时间、技术问题、中转和并发症，以及术后疼痛、恢复日常活动时间和停工时间。
98 例（87.5%）患者在日间手术中进行了手术，14 例（12.5%）患者在过夜留观。疝和补片的平均大小分别为 9（1-50）cm 和 225（50-500）cm。手术时间平均为 75（30-270）min。43 例（38.4%）患者打开了腹膜，并在 41 例中缝合关闭。有 5 例（4.5%）中转 IPOM，4 例（3.6%）并发症（1 例血清肿、1 例尿潴留、1 例暂时性肠梗阻和 1 例肠梗阻）需要再次手术。术后疼痛的平均视觉模拟评分（VAS）为 2.45（0-8），17 例（15%）患者评分 0。恢复日常活动和工作的平均时间分别为 4（1-15）天和 11.5（1-30）天。
我们的结果表明，熟练的腹腔镜外科医生可以安全地进行 VTEP，并且可能有助于减轻疼痛，尽管这必须通过对照研究来确定。
