Department of Surgery, Division of Minimally Invasive Surgery, Washington University, Saint Louis, MO.
Department of Surgery, Division of Minimally Invasive Surgery, Washington University, Saint Louis, MO.
Surgery. 2022 Mar;171(3):806-810. doi: 10.1016/j.surg.2021.08.067. Epub 2021 Dec 20.
Recurrent hernias pose significant challenges due to violated anatomic planes, resultant scar, and potential prior mesh. Transversus abdominis release has been widely utilized for complex hernias. Transversus abdominis release can provide a novel plane for dissection and mesh placement for recurrent hernias. This study provides our institution's experience with transversus abdominis release in patients with recurrent ventral hernias.
A retrospective chart review was conducted of patients with recurrent ventral hernias from January 2018 to September 2020 who underwent transversus abdominis release by 2 fellowship-trained abdominal wall surgeons. Combined procedures (ie, gynecological/urological), robotic totally extraperitoneal, and emergency cases were excluded. Demographics, perioperative, and postoperative outcomes were reviewed.
In total, 108 patients underwent open-transversus abdominis release and 25 had robotic-transversus abdominis release for recurrent ventral hernias. All patients received a lightweight to midweight nonabsorbable polypropylene synthetic mesh. Mean age was 59, mean body mass index was 34 kg/m, with mean hernia defect area of 333 cm. We noted 34 (25.6%) surgical site occurrences and 11 (8.3%) surgical site infections. Mean postoperative follow-up was 15.5 months, with 7 (5%) recurrences (6 open-transversus abdominis release, 1 robotic-transversus abdominis release). A minimum 12-month follow-up was available for 62% of patients, and minimum 6-month follow-up in 80% of patients.
Recurrent hernias pose significant operative challenges for surgeons due to violated tissue planes and limited repair options. Our experience suggests that transversus abdominis release may provide a durable repair for difficult recurrent ventral hernias. However, long-term postoperative follow-up over multiple years is still needed to establish extended durability of transversus abdominis release in these patients.
复发性疝由于解剖平面受损、疤痕形成和潜在的先前补片而带来重大挑战。腹横肌松解术已广泛应用于复杂疝。腹横肌松解术可为复发性疝提供新的解剖平面和补片放置。本研究介绍了我们机构对复发性腹侧疝患者行腹横肌松解术的经验。
对 2018 年 1 月至 2020 年 9 月期间由 2 名接受过腹横肌松解术培训的腹壁外科医生进行复发性腹侧疝患者的回顾性图表审查。排除联合手术（即妇科/泌尿科）、机器人全腹膜外和急诊病例。回顾了人口统计学、围手术期和术后结果。
总共 108 例患者行开放腹横肌松解术，25 例行机器人腹横肌松解术治疗复发性腹侧疝。所有患者均接受了轻至中重量非吸收性聚丙烯合成补片。平均年龄为 59 岁，平均体重指数为 34kg/m，平均疝缺损面积为 333cm。我们注意到 34 例（25.6%）手术部位并发症和 11 例（8.3%）手术部位感染。平均术后随访时间为 15.5 个月，7 例（5%）复发（6 例开放腹横肌松解术，1 例机器人腹横肌松解术）。62%的患者可获得至少 12 个月的随访，80%的患者可获得至少 6 个月的随访。
复发性疝由于组织平面受损和有限的修复选择，给外科医生带来了重大手术挑战。我们的经验表明，腹横肌松解术可为困难的复发性腹侧疝提供持久的修复。然而，仍需要多年的长期术后随访，以确定该技术在这些患者中的长期耐久性。
