Institut de la hernie Paris, 15 Rue du Cirque, 75008, Paris, France.
Surg Endosc. 2022 Jul;36(7):5313-5318. doi: 10.1007/s00464-021-08911-2. Epub 2021 Dec 2.
Techniques of retromuscular repair of ventral hernias aim at avoiding complications linked to intraperitoneal patch. Aim of the study was to evaluate results of the VTEP technique.
On 187 patients who underwent a VTEP, evaluation was carried out on 128 patients with a minimum follow-up of 1 year. The surgical technique consisted of creating connection between both retro-rectus spaces, by division of the medial edges of the posterior sheath and deploying the patch in the retromuscular patch without fixation. The posterior sheath was repaired in 16 cases. The patients were sent a questionnaire and invitation to have physical examination by the surgeon.
The mean hernia and patch size were 9 (1-50) and 225 (50-500) cm, respectively. The mean follow-up was 21.2 (12-35) months; 120 (93.7%) patients were evaluated, 21 by physical examination, 41 by questionnaire, 58 by telephone and 8 (6.3%) were lost to follow-up. Hundred (83%) patients felt no pain at rest, and 88 (73%) during effort. Among patients who felt some degree of pain, the mean VAS value was 2 (1-4) at rest and 2.6 (1-7) during effort. Two recurrences occurred, 3 patients were worried about a persisting diastasis bulging at the upper border of the patch and 8 patients in which the posterior sheath was not repaired complained they felt that their upper abdomen was somewhat distended or swollen.
The VTEP procedure provides a low level of chronic pain but can entail some drawbacks, such as the swollen abdomen, which can be attributed to the absence of repair of the posterior sheath. It may be that restoring or preserving structural integrity of the abdominal belt formed by the posterior sheath constitutes a key point in retromuscular techniques.
腹外疝的腹横筋膜后修补技术旨在避免与腹腔内补片相关的并发症。本研究旨在评估 VTEP 技术的结果。
对 187 例接受 VTEP 治疗的患者进行了研究，其中 128 例患者获得了至少 1 年的随访。手术技术包括通过切开后鞘的内侧缘，在无固定的情况下在腹横筋膜后间隙之间建立连接，并将补片置于腹横筋膜后间隙。在后鞘修补 16 例。患者被发送了一份问卷和由外科医生进行体格检查的邀请。
疝和补片的平均大小分别为 9（1-50）cm 和 225（50-500）cm。平均随访时间为 21.2（12-35）个月；120 例（93.7%）患者接受了评估，其中 21 例接受了体格检查，41 例接受了问卷调查，58 例接受了电话随访，8 例（6.3%）失访。100 例（83%）患者在休息时无疼痛，88 例（73%）在用力时无疼痛。在感到某种程度疼痛的患者中，VAS 平均值为休息时 2（1-4），用力时 2.6（1-7）。发生了 2 例复发，3 例患者对补片上缘持续存在的分离膨出感到担忧，8 例未修复后鞘的患者抱怨感到上腹部有些肿胀或肿胀。
VTEP 手术可导致慢性疼痛程度较低，但可能存在一些缺陷，例如腹部肿胀，这可能归因于后鞘未修复。恢复或保持由后鞘形成的腹横筋膜后间隙的结构完整性可能是腹横筋膜后技术的关键。
