Sánchez García C, Osorio I, Bernar J, Fraile M, Villarejo P, Salido S
Endocrine, Breast and Minimally Invasive Abdominal Wall Surgery Unit, General Surgery Department, Fundación Jiménez Díaz University Hospital, Avenida de los Reyes Católicos, 2, 28040, Madrid, Spain.
Endocrine, Breast and Minimally Invasive Abdominal Wall Surgery Unit, General Surgery Department, Villalba General Hospital, Madrid, Spain.
Hernia. 2022 Dec;26(6):1605-1610. doi: 10.1007/s10029-022-02581-2. Epub 2022 Mar 10.
Obesity is a risk factor for developing abdominal wall hernias and is associated with major postoperative complications, such as surgical site infection, delayed wound healing and recurrent hernia. Therefore, treating incisional hernia in this patient subgroup is a challenge.
We conducted a comparative, prospective study on patients who underwent primary ventral hernia surgery or incisional hernia surgery through the extended totally extraperitoneal pathway, with body mass indices (BMIs) ≤ 30 (no obesity) and BMI > 30 (with obesity). We collected demographic data, preoperative and intraoperative variables, complication and recurrence rate, hospital stay and follow-up as postoperative data.
From May 2018 to December 2020, 74 patients underwent this surgery, 38 patients without obesity and 36 with obesity. The median area of the hernia defect measured by CT was 57 cm and 93 cm in patients without and with obesity, respectively (p = 0.012). The median follow-up was 16 months. One patient without obesity experienced some postoperative complication compared with four patients with obesity (p > 0.05). No patient without obesity had recurrent hernia compared with two patients with obesity (p > 0.05).
There were statistically significant differences between patients with and without obesity in the size of the hernia defect. However, there were no significant differences in terms of complications, hospital stay, postoperative pain or relapses. Therefore, the minimally invasive completely extraperitoneal approach for patients with obesity appears to be a safe procedure despite our study limitations. Studies with longer follow-ups and a greater number of patients are needed.
肥胖是腹壁疝发生的危险因素，且与术后主要并发症相关，如手术部位感染、伤口愈合延迟和复发性疝。因此，治疗该患者亚组的切口疝具有挑战性。
我们对通过扩大完全腹膜外途径接受原发性腹疝手术或切口疝手术的患者进行了一项比较性前瞻性研究，这些患者的体重指数（BMI）≤30（无肥胖）和BMI>30（有肥胖）。我们收集了人口统计学数据、术前和术中变量、并发症和复发率、住院时间以及作为术后数据的随访情况。
2018年5月至2020年12月，74例患者接受了该手术，38例无肥胖患者和36例有肥胖患者。CT测量的疝缺损中位面积在无肥胖患者和有肥胖患者中分别为57平方厘米和93平方厘米（p = 0.012）。中位随访时间为16个月。1例无肥胖患者出现了一些术后并发症，而有肥胖患者中有4例出现（p>0.05）。无肥胖患者中无复发性疝病例，而有肥胖患者中有2例（p>0.05）。
肥胖患者和非肥胖患者在疝缺损大小方面存在统计学上的显著差异。然而，在并发症、住院时间、术后疼痛或复发方面没有显著差异。因此，尽管我们的研究存在局限性，但对于肥胖患者采用微创完全腹膜外方法似乎是一种安全的手术。需要进行随访时间更长、患者数量更多的研究。
