Department of Surgery, University of Connecticut School of Medicine, Farmington, CT.
Department of General Surgery, Hartford Health Care, Hartford, CT.
CRSLS. 2023 Jun 9;10(2). doi: 10.4293/CRSLS.2023.00015. eCollection 2023 Apr-Jun.
Pelvic floor hernias represent a rare type of hernia and a rare etiology of pelvic symptoms. The rarest type of pelvic floor hernias are sciatic hernias, which present with a variety of symptoms depending on the hernia contents and location. Many different treatment approaches are described in the literature. A 73-year-old female presented to our outpatient minimally invasive surgery (MIS) clinic with one year of colicky left flank pain. She had previously presented to an emergency department, at which time a computed tomography (CT) scan demonstrated left-sided hydronephrosis in the setting of a left-sided ureterosciatic hernia. She was asymptomatic and had no palpable hernia bulge. An operative repair was offered based on her prolonged symptoms. The patient was brought electively to the operating room with minimally invasive and urological surgeons. A left ureteral stent was placed over a guidewire. A robotic repair was performed with a round piece of biosynthetic mesh, secured in place with fibrin glue. Sciatic hernias are an extremely rare etiology of pelvic symptoms and require a high index of suspicion to identify. Obstructive and neuropathic symptoms may be intermittent, so diagnosis is often made using CT imaging. We report a successful treatment with pre-operative ureteral stenting followed by a robotic repair using biologic mesh secured with fibrin glue fixation. We believe this is a durable repair although acknowledge that longer follow-up is needed to establish the longevity of our treatment modality.
骨盆底疝是一种罕见的疝类型，也是骨盆症状的罕见病因。骨盆底疝中最罕见的类型是坐骨疝，其表现出多种症状，具体取决于疝内容物和位置。文献中描述了许多不同的治疗方法。一位 73 岁的女性因左侧腰痛绞痛一年来到我们的门诊微创外科 (MIS) 诊所就诊。她曾到急诊就诊，当时 CT 扫描显示左侧肾盂积水，左侧输尿管坐骨疝。她无症状，无可触及的疝膨出。根据她的长期症状，建议进行手术修复。该患者在微创外科医生和泌尿科医生的帮助下择期进入手术室。在导丝上放置了左侧输尿管支架。使用圆形生物合成网进行机器人修复，并用纤维蛋白胶固定。坐骨疝是骨盆症状的一种极其罕见的病因，需要高度怀疑才能识别。梗阻性和神经病变性症状可能是间歇性的，因此通常使用 CT 成像进行诊断。我们报告了一例成功的治疗病例，在术前放置输尿管支架后，使用生物网进行机器人修复，并使用纤维蛋白胶固定。我们认为这是一种持久的修复方法，但承认需要更长时间的随访来确定我们治疗方式的长期效果。
