Puerta de Hierro Majadahonda University Hospital, C. Joaquín Rodrigo, 1, 28222, Majadahonda, Madrid, Spain.
Autónoma de Madrid University, Madrid, Spain.
Surg Endosc. 2022 Dec;36(12):9072-9091. doi: 10.1007/s00464-022-09375-8. Epub 2022 Jun 28.
The best approach for lateral incisional hernia is not known. Posterior component separation (reverse TAR) offers the possibility of using the retromuscular space for medial extension of the challenging preperitoneal plane. The aim of our multicenter study was to compare the operative and patient-reported outcomes measures (PROMs) using two open surgical techniques from the lateral approach: a totally preperitoneal vs a reverse TAR.
A retrospective cohort study was performed since 2012 to 2020. Patients with lateral incisional hernia treated through a lateral approach were identified from a prospectively maintained multicenter database. Reverse TAR was added when the preperitoneal plane could not be safely dissected. The results obtained using these two lateral approaches were compared, including short- and long-term complications, as well as PROMs, using the specific tool EuraHSQoL.
A total of 61 patients were identified. Reverse TAR was performed in 33 patients and lateral retromuscular preperitoneal approach in 28 patients. Both groups were comparable in terms of sociodemographic and comorbidities variables. Surgical site occurrences occurred in 13 cases (21.3%), with 8 patients (13.1%) requiring procedural intervention. During a median follow-up of 34 months, no incisional hernia recurrence was registered. There was a case (1.6%) of symptomatic bulging that required reoperation. Also 12 patients (19.7%) presented an asymptomatic bulging. No statistically significant difference was identified in the complications and PROMs between the two procedures.
The open lateral retromuscular reconstruction using very large meshes that reach the midline has excellent long-term results with acceptable postoperative complications, including PROMs. A reverse TAR may be added, when necessary, without increasing complications and obtaining similar long-term results.
对于侧方切口疝，最佳的治疗方法尚不清楚。后入路分离技术（reverse TAR）为经腹直肌后间隙向内侧延伸困难的腹膜前间隙提供了可能。本多中心研究的目的是比较两种从侧方入路的开放手术技术的手术和患者报告的结局测量（PROMs）：完全腹膜前 vs. reverse TAR。
自 2012 年至 2020 年进行了回顾性队列研究。从一个前瞻性维持的多中心数据库中确定了通过侧方入路治疗的侧方切口疝患者。当无法安全解剖腹膜前平面时，加用 reverse TAR。使用特定的 EuraHSQoL 工具比较这两种侧方入路的结果，包括短期和长期并发症以及 PROMs。
共纳入 61 例患者。33 例患者行 reverse TAR，28 例患者行侧方经腹直肌后腹膜前入路。两组在社会人口统计学和合并症变量方面具有可比性。13 例（21.3%）发生手术部位并发症，8 例（13.1%）需要手术干预。在中位随访 34 个月期间，无切口疝复发。有 1 例（1.6%）有症状性膨出，需要再次手术。还有 12 例（19.7%）出现无症状性膨出。两种手术方法的并发症和 PROMs 无统计学差异。
使用非常大的网片进行侧方经腹直肌后重建，可达到中线，具有出色的长期结果，术后并发症可接受，包括 PROMs。当需要时，可以加用 reverse TAR，而不会增加并发症，并获得类似的长期结果。
