Amiki Manabu, Ishiyama Yasuhiro, Mochizuki Ichitaro, Narita Kazuhiro, Goto Manabu, Sekikawa Koji
Kawasaki Saiwai Hospital, 31-27 Omiya-Cho, Saiwai-Ku, Kawasaki City, Kanagawa, 212-0014, Japan.
Surg Case Rep. 2023 Feb 20;9(1):27. doi: 10.1186/s40792-023-01610-1.
Ventral hernia repair (VHR) for obese patients is often associated with an increased risk of postoperative complications and hernia recurrences. Achieving preoperative weight loss is ideal before VHR; however, it is difficult to attain with medical treatment. Metabolic and bariatric surgery (MBS) offers the most effective and durable treatment for obesity. Therefore, massive weight loss occurring after MBS will improve the outcome of VHR.
A 49-year-old man (122.9 kg, BMI 39.1 kg/m) presented to our hospital wishing to undergo laparoscopic sleeve gastrectomy and VHR. Physical examination revealed a tennis ball-sized lower midline defect. Computed tomography (CT) scans revealed a hernia orifice 5 cm in width and 10 cm in height. As the hernia orifice was large, mesh reinforcement was essential. We planned for him to undergo VHR after massive weight loss was achieved by MBS. VHR was performed using the enhanced-view totally extraperitoneal (eTEP) technique after weight loss of 38 kg was achieved 9 months following laparoscopic sleeve gastrectomy. His postoperative course was uneventful, and neither recurrence nor seroma was observed at 1 year follow-up.
eTEP repair of a ventral hernia after massive weight loss following MBS would appear to be the best combination treatment for obese patients with ventral hernias. However, long-term follow-up is necessary to establish its safety and efficacy.
肥胖患者的腹疝修补术（VHR）术后并发症和疝复发风险通常会增加。VHR术前实现体重减轻是理想的；然而，药物治疗很难实现这一点。代谢和减重手术（MBS）为肥胖提供了最有效且持久的治疗方法。因此，MBS后出现的大量体重减轻将改善VHR的效果。
一名49岁男性（体重122.9千克，BMI为39.1千克/米²）到我院就诊，希望接受腹腔镜袖状胃切除术和VHR。体格检查发现一个网球大小的中线下方缺损。计算机断层扫描（CT）显示疝孔宽5厘米、高10厘米。由于疝孔较大，补片加强至关重要。我们计划在他通过MBS实现大量体重减轻后为他进行VHR。在腹腔镜袖状胃切除术后9个月体重减轻38千克后，采用增强视野完全腹膜外（eTEP）技术进行了VHR。他的术后过程顺利，在1年随访中未观察到复发或血清肿。
MBS后大量体重减轻后采用eTEP修补腹疝似乎是肥胖腹疝患者的最佳联合治疗方法。然而，需要长期随访以确定其安全性和有效性。
