Department of Surgery, Division of General Surgery, University of Toronto, Toronto, ON, Canada.
Department of General Surgery, Division of General Surgery, North York General Hospital, North York, ON, Canada.
Hernia. 2022 Jun;26(3):945-951. doi: 10.1007/s10029-021-02443-3. Epub 2021 Jul 23.
Currently there is no consensus regarding the optimal surgical approach to an incisional hernia measuring less than 10 cm. Certain hernia features including defect size, intra-abdominal adhesions, and overlying scar/skin properties contribute to choosing an open versus a laparoscopic approach. This retrospective cohort study was designed to compare incisional hernia defects repaired with laparoscopic suture closure to a hybrid approach with open defect closure, both with laparoscopic intraperitoneal onlay mesh (IPOM) reinforcement.
We identified 164 consecutive patients who underwent incisional hernia repair from two centers, North York General Hospital (NYGH) and Humber River Hospital (HRH) between 2015 and 2020. Patients were grouped by totally laparoscopic or hybrid fascial closure. Both techniques included laparoscopically placed intra-peritoneal mesh with 5 cm of overlap in all directions. Patients were analyzed by age, sex, body mass index (BMI), ASA class and hernia size. Primary outcomes included surgical site infection (SSI), other wound complications including seroma/hematoma, length of hospital stay, pain reported at follow-up appointment, and hernia recurrence.
Post-operative pain, surgical site infections and seromas did not differ between the totally laparoscopic and hybrid approach. The recurrence rates were 5.8% and 6.8% for the laparoscopic and hybrid group, respectively, which were not significantly different. The time to recurrence was 15 months (range 8-12) in the laparoscopic group and 7 months (range 6-36) in the hybrid group, also not significantly different. The hernia defect size and BMI were significantly higher in the hybrid group, without increased wound complications.
These results suggest that a hybrid approach to incisional ventral hernia repair with open defect closure is comparable to a totally laparoscopic closure. The hybrid technique can help facilitate fascial closure and resection of the hernia sac in patients with higher BMI and hernia defects up to 6 cm.
目前对于小于 10cm 的切口疝，尚无关于最佳手术入路的共识。某些疝特征，包括缺损大小、腹腔内粘连和覆盖的疤痕/皮肤特性，有助于选择开放手术与腹腔镜手术。本回顾性队列研究旨在比较腹腔镜缝合关闭与混合方法（开放缺损关闭，同时行腹腔镜腹腔内补片加强）治疗切口疝缺损的效果。
我们从 2015 年至 2020 年在两家医院（北约克综合医院和汉伯河医院）中确定了 164 例连续接受切口疝修复的患者。患者按完全腹腔镜或混合筋膜关闭分组。两种技术均包括在所有方向上放置 5cm 重叠的腹腔镜腹腔内补片。根据年龄、性别、体重指数（BMI）、ASA 分级和疝大小对患者进行分析。主要结局包括手术部位感染（SSI）、其他伤口并发症（包括血清肿/血肿）、住院时间、随访时报告的疼痛以及疝复发。
完全腹腔镜与混合方法之间的术后疼痛、手术部位感染和血清肿无差异。腹腔镜组和混合组的复发率分别为 5.8%和 6.8%，差异无统计学意义。腹腔镜组的复发时间为 15 个月（8-12 个月），混合组为 7 个月（6-36 个月），差异也无统计学意义。混合组的疝缺损大小和 BMI 明显更高，但伤口并发症没有增加。
这些结果表明，对于 BMI 较高和疝缺损达 6cm 的患者，采用开放缺损闭合的混合方法治疗切口腹疝修复与完全腹腔镜闭合相当。混合技术可以帮助在 BMI 较高和疝缺损较大的患者中更容易地进行筋膜闭合和疝囊切除。
