Montorfano Lisandro, Szomstein Samuel, Valera Roberto J, Bordes Stephen J, Sarmiento Cobos Mauricio, Quirante Frederico P, Lo Menzo Emanuele, Rosenthal Raul J
Surgery, Cleveland Clinic Florida, Weston, USA.
Bariatric and Minimally Invasive Surgery, Cleveland Clinic Florida, Weston, USA.
Cureus. 2022 Feb 23;14(2):e22523. doi: 10.7759/cureus.22523. eCollection 2022 Feb.
Purpose The aim of this study is to describe the safety and effectiveness of laparoscopic ventral hernia repair with intraperitoneal fascial closure using a barbed suture prior to mesh placement. Materials and methods Patients who underwent laparoscopic ventral hernia repair were included in this retrospective review. Patients were divided into two groups. In the first group, primary fascial closure was performed with a 2-polypropylene non-absorbable unidirectional barbed suture followed by fixation of the intraperitoneal mesh. In the second group, the mesh was fixed intraperitoneally using tacks without closing the fascial defect. Results A total of 148 patients who underwent laparoscopic primary ventral hernia repair were included. A total of 72 (48.6%) patients were included in the barbed suture with mesh group and 76 (51.4%) patients in the mesh-only group. The mean fascial defect size was 25 cm in the first group and 64 cmin the second group. The median suturing time for fascial closure was 15 minutes. The average surgery time was 98 minutes in the first group and 96 minutes in the second group. The mean follow-up period was 80 days for Group 1 and 135 days for Group 2. No hernia recurrence or mortality occurred in this study. Conclusion The barbed suture closure technique is a fast, safe, and effective technique for fascial closure during laparoscopic ventral hernia repair in combination with mesh placement. Further evidence to support these findings and longer follow-up periods are warranted to evaluate long-term outcomes.
目的 本研究旨在描述在放置补片前使用倒刺缝线进行腹膜内筋膜闭合的腹腔镜腹疝修补术的安全性和有效性。材料与方法 本回顾性研究纳入了接受腹腔镜腹疝修补术的患者。患者被分为两组。第一组，先用2-聚丙烯不可吸收单向倒刺缝线进行一期筋膜闭合，然后固定腹膜内补片。第二组，不闭合筋膜缺损，使用钉合器将补片固定于腹膜内。结果 总共纳入了148例行腹腔镜原发性腹疝修补术的患者。倒刺缝线加补片组共72例（48.6%）患者，单纯补片组76例（51.4%）患者。第一组筋膜缺损平均大小为25 cm，第二组为64 cm。筋膜闭合的中位缝合时间为15分钟。第一组平均手术时间为98分钟，第二组为96分钟。第一组平均随访期为80天，第二组为135天。本研究中未发生疝复发或死亡。结论 倒刺缝线闭合技术是一种在腹腔镜腹疝修补术联合补片放置过程中进行筋膜闭合的快速、安全且有效的技术。需要进一步的证据来支持这些发现，并进行更长时间的随访以评估长期结果。
