Department of Minimal Access and Bariatric Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi, 110060, India.
Institute of Minimal Access, Metabolic and Bariatric Surgery, Sir Ganga Ram Hospital, Room No 400, SWB Block, 4th Floor, Rajinder Nagar, New Delhi, 110060, India.
Hernia. 2022 Oct;26(5):1325-1336. doi: 10.1007/s10029-022-02671-1. Epub 2022 Sep 10.
Lateral abdominal wall hernias (LAWH) constitute about 1-4% of hernia surgical procedures. They represent a unique surgical challenge on account of their potential for anatomical complexity and consequent operative technical demand. Furthermore, LAWH repairs are currently not standardized, and remain contentious, despite a variety of approaches. These repairs are attendant with not insignificant morbidity and recurrence rates. We profile here our endoscopic and hybrid surgical approach to the management of LAWH and early therapeutic outcomes.
A retrospective review of our hernia clinical database between March 2018 and December 2020 was performed to extract all LAWH (with and without an associated midline component) patients, who underwent an enhanced-view totally extra peritoneal (eTEP) hernia repair with a transversus abdominis release (TAR), or a hybrid repair. Initial outcome data (6-month follow-up) is profiled here. The primary outcome measures were hernia recurrence and hernia-site bulging. The secondary measures were surgical site occurrence (SSO) and hernia-related quality of life (QoL).
A total of 33 LAWH patients underwent an eTEP TAR or hybrid hernia repair. 11 patients had an associated midline defect and 12 were recurrent hernias. The mean hernia defect area was 84.2 ± 49 cm and mean mesh size was 859.6 ± 263 cm. There was no hernia recurrence at initial follow-up of 24 months. The SSO rate was 12%. The CCS QoL scores were 34.6 ± 2 pre-operatively, and improved to 27.2 ± 4 at 6 months.
Our endoscopic and hybrid technique is a safe, reproducible, and technically promising approach for the repair of LAWH. Thorough knowledge of the surgical anatomy of the lateral abdominal wall and advanced endosurgical skills are imperative for good outcomes. We await the long-term results of our LAWH cohort to confirm the findings.
侧腹壁疝（LAWH）约占疝手术的 1-4%。由于其潜在的解剖复杂性和相应的手术技术需求，它们代表了一个独特的手术挑战。此外，尽管有多种方法，但 LAWH 的修复目前尚未标准化，仍存在争议。这些修复伴随着相当大的发病率和复发率。我们在这里介绍我们内镜和混合手术方法治疗 LAWH 和早期治疗结果。
对 2018 年 3 月至 2020 年 12 月期间我们的疝临床数据库进行回顾性分析，以提取所有接受增强视图完全腹膜外（eTEP）疝修补术伴腹横肌释放（TAR）或混合修补术的 LAWH（有或无中线成分）患者。在此处介绍初始结果数据（6 个月随访）。主要观察指标为疝复发和疝部位隆起。次要观察指标为手术部位发生（SSO）和疝相关生活质量（QoL）。
共有 33 例 LAWH 患者接受了 eTEP TAR 或混合疝修补术。11 例患者存在中线缺陷，12 例为复发性疝。平均疝缺损面积为 84.2±49cm，平均补片面积为 859.6±263cm。在 24 个月的初始随访中，无疝复发。SSO 发生率为 12%。CCS QoL 评分术前为 34.6±2，术后 6 个月改善至 27.2±4。
我们的内镜和混合技术是一种安全、可重复、技术上有前途的治疗 LAWH 的方法。对侧腹壁的外科解剖有深入的了解和先进的内镜技能对于获得良好的结果至关重要。我们正在等待我们的 LAWH 队列的长期结果来证实这些发现。
