Kumar Nitesh, Jaiswal Pradeep, Sinha Nirupam, Pankaj Deepak, Bhushan Vibhuti, Jha Pawan Kumar, Muni Sweta
Department of General Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Department of Microbiology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.
Maedica (Bucur). 2022 Jun;17(2):329-335. doi: 10.26574/maedica.2022.17.2.329.
The field of abdominal wall hernias has undergone many innovations. Ventral hernias have conventionally been treated by open on-lay mesh hernioplasty, open retromuscular mesh hernioplasty (Rives-Stoppa procedure) and laparoscopic intraperitoneal mesh hernioplasty. To develop an alternative strategy where a mesh is placed in retromuscular space by minimal access technique of the laparoscopic extended view totally extraperitoneal approach (e-TEP). This was an interventional and prospective study on series of 25 cases of either sex with age ≥18 years and ≤65 years presenting with umbilical hernia with abdominal wall defect. Laparoscopic e-TEP (extended view totally extraperitoneal repair) for umbilical hernia was performed and patients were usually discharged within 48.72 hours of the procedure. Follow-up surveillance for complications and recurrence of hernia was performed in an outpatient clinic the sixth week after surgery and by telephonic conversation every sixth months. Demographic profile, medical history, preoperative (comorbidities), perioperative and postoperative (during hospital stay) clinical profile of each patient was documented. Among our study participants there was a female preponderance, with a male to female ratio of 0.47:1. Patients' ages ranged from 27 to 61 years, with a mean (SD) of 41.7 (11.4) years. Average defect size was 4.2 cm². One hernia involved divarication of recti muscles. A polypropylene mesh of size 15 x 15 cm was placed. The mean operative times were 94 minutes, ranging from 60 to 120 minutes. The average hospital stay was three days. The mean follow-up period was 12.6 months. Two patients developed seroma at umbilicus with discharge from suture site which resolved in two weeks with regular dressing. Prolonged ileus was noted in two patients, which resolved spontaneously by the fourth day. None of the patients developed surgical site infection, skin necrosis, wound dehiscence, bowel obstruction, urinary complications, or deep vein thrombosis. Also, none of the patients required conversion to open surgery. The current study generates evidence in support of this technique to be adapted in centers with advanced laparoscopic skills.
腹壁疝领域已经历了许多创新。传统上，腹疝的治疗方法包括开放的补片外置修补术、开放的肌后补片修补术（里夫斯 - 斯托帕手术）和腹腔镜腹膜内补片修补术。为了开发一种替代策略，即通过腹腔镜扩大视野完全腹膜外入路（e - TEP）的微创技术将补片放置在肌后间隙。这是一项针对25例年龄≥18岁且≤65岁、患有脐疝且伴有腹壁缺损的男女患者的干预性前瞻性研究。对脐疝进行了腹腔镜e - TEP（扩大视野完全腹膜外修补术），患者通常在手术后48.72小时内出院。术后第六周在门诊诊所对并发症和疝复发情况进行随访监测，并每六个月通过电话进行沟通。记录了每位患者的人口统计学资料、病史、术前（合并症）、围手术期和术后（住院期间）的临床资料。在我们的研究参与者中女性占优势，男女比例为0.47:1。患者年龄在27岁至61岁之间，平均（标准差）为41.7（11.4）岁。平均缺损大小为4.2平方厘米。1例疝涉及腹直肌分离。放置了一块尺寸为15×15厘米的聚丙烯补片。平均手术时间为94分钟，范围为60至120分钟。平均住院时间为三天。平均随访期为12.6个月。两名患者在脐部出现血清肿，缝线部位有渗液，经定期换药两周后消退。两名患者出现了麻痹性肠梗阻，在第四天自行缓解。没有患者发生手术部位感染、皮肤坏死、伤口裂开、肠梗阻、泌尿系统并发症或深静脉血栓形成。此外，没有患者需要转为开放手术。本研究为支持在具备先进腹腔镜技术的中心采用该技术提供了证据。
