Philipp Mark, Leuchter Matthias, Klar Ernst
Department of General, Visceral, Vascular, and Transplantation Surgery, University Medical Center of Rostock, Rostock, Germany.
Visc Med. 2020 Aug;36(4):326-332. doi: 10.1159/000505247. Epub 2020 Jan 14.
Component separation (CS) for tension-free approximation of fascial edges is the established technique for the repair of large ventral hernias mostly regarding midline defects. Recent studies suggest lower complication rates following a modified version of this technique using a partially endoscopic-assisted approach, whereas little is known about the quality of life (QoL) in the long-term evaluation of these patients.
A retrospective study and analysis of patients undergoing hernia repair using an open CS (OCS) and endoscopically assisted CS (ECS) technique, respectively, from 2011 to 2016 at the Rostock University Medical Center. Patients underwent a mesh-based sublay reinforcement following a distinct CS with closure of the linea alba. Patient characteristics, technical details, and short-term postoperative outcomes were determined by a physician chart review. A health-related QoL survey (EQ-5D) including a pain assessment was evaluated at a median of 19.5 months postoperatively.
Thirty-five patients had a CS: 25 OCS and 10 ECS. Perioperative variables were comparable except for the median defect size (169 cm OCS vs. 86 cm ECS; < 0.05) and maximum width of hernia (25 vs. 13 cm). Hospitalization lasted 16.6 days in the OCS group and 7.9 days in the endoscopic group ( = 0.04). Wound complications occurred in 24% of OCS and 10% of ECS patients.
Patients in the ECS group had a shorter hospital stay and less minor and major wound complications. These advantages led to a faster recovery directly affecting the QoL in the ECS group. This effect diminishes in the long-term follow-up with a positive trend towards the OCS technique.
用于无张力拉近筋膜边缘的成分分离术（CS）是修复大多涉及中线缺损的大型腹疝的既定技术。近期研究表明，采用部分内镜辅助方法的该技术改良版术后并发症发生率较低，而对于这些患者的长期生活质量（QoL）了解甚少。
对2011年至2016年在罗斯托克大学医学中心分别采用开放成分分离术（OCS）和内镜辅助成分分离术（ECS）进行疝修补的患者进行回顾性研究与分析。患者在进行独特的成分分离术并关闭白线后接受基于补片的腹膜前加固。通过医生查阅病历确定患者特征、技术细节和术后短期结果。在术后中位数19.5个月时评估包括疼痛评估在内的与健康相关的生活质量调查（EQ-5D）。
35例患者接受了成分分离术：25例采用OCS，10例采用ECS。除了中位数缺损大小（OCS为169平方厘米 vs. ECS为86平方厘米；<0.05）和疝的最大宽度（25厘米 vs. 13厘米）外，围手术期变量具有可比性。OCS组住院时间为16.6天，内镜组为7.9天（=0.04）。OCS组24%的患者和ECS组10%的患者发生伤口并发症。
ECS组患者住院时间较短，大小伤口并发症较少。这些优势导致恢复更快，直接影响了ECS组的生活质量。在长期随访中这种效果减弱，OCS技术呈积极趋势。
