The Wesley Hospital, Brisbane, Queensland, Australia.
The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
ANZ J Surg. 2022 Oct;92(10):2529-2533. doi: 10.1111/ans.17508. Epub 2022 Feb 9.
Ventral hernias are increasingly managed with minimally invasive laparoscopic surgery. Invasive open surgery is typically used for the repair of large-sized hernias (>10 cm diameter). The two methods are often considered mutually exclusive. We report a hybrid technique for repair of medium to large-sized hernias.
Data was collected prospectively from 44 hernias repaired using the hybrid technique from 2012 to 2020. Operative data was examined and follow-up conducted by both clinical and phone review. As for surgical technique, laparoscopic access was established via a 5 mm optical port and two (or more) 5 mm ports were added under vision. Hernia contents were reduced and extraperitoneal fat excised around the defect. Hernias with diameters ranging from 5 to 10 cm were fixed using the hybrid technique. A small incision was made directly over the hernia and polyester mesh was placed intraabdominally before defect closure with a transfascial suture. Pneumoperitoneum was re-established and mesh fixation achieved using absorbable tacks and/or fixation sutures.
Of the 44 ventral hernias repaired with the hybrid technique, 43 were secondary hernias from incisional defects. Average hernia diameter was 6.6 cm. 86% of patients were discharged within the first 48 h. Four patients (9%) had recurrences during the study period. Minor complications occurred in 8 patients (18%): 3 (7%) had post-operative wound infection, 3 patients (7%) developed post-operative seroma. Two patients (5%) had clinically significant wound haematoma.
Laparoscopic hybrid ventral hernia repair can be safely performed by a combination of laparoscopic and open techniques, offering an alternative method in the management of medium-sized ventral hernias.
腹疝越来越多地采用微创腹腔镜手术治疗。对于直径较大的疝（>10cm），通常采用有创的开放式手术进行修复。这两种方法通常被认为是相互排斥的。我们报告了一种用于修复中大型疝的混合技术。
从 2012 年至 2020 年，我们前瞻性地收集了 44 例采用混合技术修复的疝病例数据。通过临床和电话随访检查手术数据。对于手术技术，通过 5mm 光学端口建立腹腔镜通道，并在直视下添加两个（或更多）5mm 端口。将疝内容物减少，并切除缺损周围的腹膜外脂肪。对于直径为 5-10cm 的疝，采用混合技术固定。在疝上方直接做一个小切口，在缺损闭合前将聚酯网片置于腹腔内，然后用筋膜间缝线进行缝合。重新建立气腹，并使用可吸收钉和/或固定缝线进行网片固定。
在采用混合技术修复的 44 例腹疝中，有 43 例为切口疝的复发性疝。平均疝直径为 6.6cm。86%的患者在 48 小时内出院。在研究期间，有 4 例（9%）患者复发。8 例患者出现轻微并发症（18%）：3 例（7%）发生术后伤口感染，3 例患者（7%）发生术后血清肿。2 例患者（5%）出现明显的伤口血肿。
腹腔镜混合式腹疝修补术可通过腹腔镜和开放技术的结合安全进行，为中大型腹疝的治疗提供了一种替代方法。
