Ali Fathalla, Sandblom Gabriel, Forgo Bianka, Wallin Göran
From the Faculty of Medicine and Health, Department of Surgery, Örebro University, Örebro, Sweden.
Department of Surgery, Karlskoga Hospital, Karlskoga, Sweden.
Ann Surg Open. 2023 Feb 2;4(1):e257. doi: 10.1097/AS9.0000000000000257. eCollection 2023 Mar.
Postoperative seroma and pain are common problems following laparoscopic intraperitoneal onlay mesh (IPOM) repair of ventral hernias. These adverse outcomes may be avoided by dissecting and using the peritoneum in the hernial sac to bridge the hernia defect.
This was a patient- and outcome assessor-blinded, parallel-design, randomized controlled trial comparing nonclosure and peritoneal bridging approaches in patients scheduled for elective midline ventral hernia repair. The primary endpoint was seroma volume on ultrasonography. The secondary endpoints were postoperative pain, recurrence, and complications.
Between November 2018 and December 2020, 112 patients were randomized, of whom 60 were in the nonclosure group and 52 were in the peritoneal bridging group. The seroma volume in the nonclosure and peritoneal bridging groups were 17 cm (6-53 cm) versus 0 cm (0-26 cm) at 1-month follow-up ( = 0.013). The median volume was zero at the 3-, 6-, and 12-month follow-ups in both groups. No significant differences were observed in early postoperative pain ( = 0.447) and in recurrence rate ( = 0.684). There were 4 (7%) and 1 (2%) perioperative complications that lead to reoperations in simple IPOM (sIPOM) and IPOM with peritoneal bridging (IPOM-pb), respectively.
Seroma was less prevalent after IPOM-pb at 1-month follow-up compared with sIPOM, with similar postoperative pain 1 week after index surgery in both groups. At subsequent follow-ups, the differences in seroma were not statistically significant. Further studies are required to confirm these results. Trial registration (NCT04229940).
腹腔镜腹腔内补片植入修补术（IPOM）治疗腹疝后，术后血清肿和疼痛是常见问题。通过在疝囊内解剖并使用腹膜来桥接疝缺损，可避免这些不良后果。
这是一项患者及结果评估者双盲、平行设计、随机对照试验，比较择期中线腹疝修补患者的不闭合和腹膜桥接两种方法。主要终点是超声检查的血清肿体积。次要终点是术后疼痛、复发和并发症。
2018年11月至2020年12月，112例患者被随机分组，其中60例在不闭合组，52例在腹膜桥接组。1个月随访时，不闭合组和腹膜桥接组的血清肿体积分别为17 cm（6 - 53 cm）和0 cm（0 - 26 cm）（P = 0.013）。两组在3个月、6个月和12个月随访时的血清肿体积中位数均为零。术后早期疼痛（P = 0.447）和复发率（P = 0.684）无显著差异。单纯IPOM（sIPOM）和腹膜桥接IPOM（IPOM - pb）分别有4例（7%）和1例（2%）围手术期并发症导致再次手术。
与sIPOM相比，IPOM - pb术后1个月随访时血清肿发生率较低，两组在初次手术后1周的术后疼痛相似。在随后的随访中，血清肿差异无统计学意义。需要进一步研究来证实这些结果。试验注册号（NCT04229940）。
