Miyasaka Mamoru, Kawarada Yo, Yamamura Yoshiyuki, Kitashiro Shuji, Okushiba Shunichi, Hirano Satoshi
Department of Surgery, Tonan Hospital, Japan.
Department of Gastroenterological Surgery II, Hokkaido University Faculty of Medicine, Japan.
Ann Med Surg (Lond). 2022 Sep 9;82:104611. doi: 10.1016/j.amsu.2022.104611. eCollection 2022 Oct.
The component separation (CS) technique is widely used for abdominal wall defects, particularly in infected wounds. CS is associated with many wound complications due to subcutaneous blood flow disturbance. Endoscopic component separation (ECS) has fewer wound complications compared to CS and has been performed recently. However, there are various port required placements for ECS, and this technique requires proficiency. One approach for ECS is the inguinal single-port approach, which can be performed from an inguinal incision similar to that used in open surgery for inguinal hernias.
We performed ECS with an inguinal single-port approach in three older adults. All patients had abdominal wall defects with infection at the central abdominal wound site. A 2-3-cm incision was created in the middle of the inguinal ligament, and a single-port surgical device with two 5-mm trocars was placed in the incision. The external oblique muscle was separated from the internal oblique muscle, and the external oblique aponeurosis was released. The muscle flap of the abdominal wall was moved to the central line. Tension-free abdominal wall closure was possible using a one-handed approach.
ECS, which has fewer wound complications, requires proficiency. This procedure is a simple and easy-to-perform procedure using an inguinal incision that surgeons are familiar with.
成分分离（CS）技术广泛应用于腹壁缺损，尤其是感染伤口。由于皮下血流紊乱，CS与许多伤口并发症相关。与CS相比，内镜下成分分离（ECS）的伤口并发症较少，且最近已开展。然而，ECS需要多种不同的端口放置位置，且该技术需要熟练掌握。ECS的一种方法是腹股沟单端口入路，可通过类似于腹股沟疝开放手术的腹股沟切口进行。
我们对三名老年人采用腹股沟单端口入路进行了ECS。所有患者在腹部中央伤口部位均有腹壁缺损并伴有感染。在腹股沟韧带中部做一个2 - 3厘米的切口，将带有两个5毫米套管针的单端口手术器械置入该切口。将腹外斜肌与腹内斜肌分离，并松解腹外斜肌腱膜。将腹壁肌瓣向中线移动。使用单手操作即可实现无张力腹壁闭合。
ECS伤口并发症较少，但需要熟练掌握。该手术是一种使用外科医生熟悉的腹股沟切口的简单易行的手术。
