Minimally Invasive Surgical Centre, Department of Surgery, National University Hospital, National University Health System (NUHS), Level 8, NUHS Tower Block, 1E Kent Ridge Road, 119228, Singapore.
General Surgery Service, Alexandra Hospital, National University Health System, Singapore.
Hernia. 2021 Apr;25(2):399-410. doi: 10.1007/s10029-020-02284-6. Epub 2020 Aug 18.
Lateral ventral hernia (LVH) is rare and can be primary or secondary. Surgical treatment of this rare hernia type is challenging due the anatomic location and technical challenges in placement and secure anchoring of mesh.
Patient demographic data, intra-operative data and post-operative outcomes on all LVH repairs performed with endo-laparoscopic and robotic approach between 2016 to 2018 were reviewed and analysed.
22 LVH were repaired in 21 patients. 9 had primary hernia and 13 had secondary hernia. All patients underwent minimally invasive surgery (MIS) for hernia repair with no conversion to open surgery. Fascial defect closure and placement of mesh were performed in all cases. Different approaches were utilized: 9 hernia repaired with laparoscopic intra-peritoneal on-lay mesh technique with defect closure (IPOM +), 4 had laparoscopic trans-abdominal pre-peritoneal repair (TAPP), another 4 had extended totally extra-peritoneal repair (eTEP), 3 had robotic TAPP (rTAPP) and 2 repaired with trans-abdominal partial extra-peritoneal (TAPE) approach. 4 (19%) of the patients developed post-operative seroma which were managed conservatively. No other significant complication was noted, and no chronic pain or recurrence reported within a minimum follow-up of 12 months.
This case series gives a broad outline of possible MIS options available for LVH repair and recommendations for a tailored approach. The surgical technique needs to be individualized according to the size and anatomic location of the defect, other intra-operative findings and patient characteristics.
侧腹疝（LVH）较为罕见，可以是原发性的，也可以是继发性的。由于该疝型的解剖位置特殊，在放置和固定补片时存在技术挑战，因此手术治疗具有一定难度。
对 2016 年至 2018 年间采用腹腔镜和机器人辅助技术治疗的所有 LVH 患者的人口统计学数据、术中数据和术后结果进行回顾性分析。
21 例患者共 22 例 LVH 接受了手术治疗。9 例为原发性疝，13 例为继发性疝。所有患者均行微创疝修补术（MIS），无中转开放手术。所有患者均行筋膜缺损修补和补片放置。采用了不同的方法：9 例采用腹腔镜腹腔内补片修补术（IPOM+）修补，4 例行腹腔镜经腹腹膜前修补术（TAPP），4 例行改良完全腹膜外修补术（eTEP），3 例行机器人 TAPP（rTAPP），2 例行经腹腹膜外部分修补术（TAPE）。4 例（19%）患者术后出现血清肿，均行保守治疗。无其他严重并发症发生，所有患者均获得了至少 12 个月的随访，无慢性疼痛或复发。
本病例系列为 LVH 修补术提供了多种微创治疗方法，并提出了个体化治疗的建议。手术技术需要根据缺损的大小和位置、其他术中发现以及患者的特点进行个体化设计。
