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视频内镜辅助下的 Rives-Stoppa 技术。“治疗腹上和脐疝合并腹直肌分离”。

Videoendoscopic assisted Rives-Stoppa technique. "Treatment for epigastric and umbilical hernias with diastasis recti".

机构信息

Centro de Patología Herniaria Argentina, Cerviño, 4449 (Zip Code 1425), Buenos Aires, Argentina.

出版信息

Hernia. 2024 Dec;28(6):2403-2409. doi: 10.1007/s10029-024-03151-4. Epub 2024 Sep 6.

DOI:10.1007/s10029-024-03151-4
PMID:39240471
Abstract

PURPOSE

There are many surgical techniques for ventral hernias and diastasis recti, both conventional or video-endoscopic, with or without mesh placement, detailed in the literature. Using some details of the techniques proposed by Wolfgang Reinpold (Mini- or Less Open Sublay Operation, MILOS) and Federico Fiori (Totally Endoscopic Sublay Anterior Repair, TESAR) we found modifications that allowed repairing and reinforcement of the posterior fascia with a retro-muscular mesh and achieve primary fascial closure by minimally umbilical access and searching for the best anatomical, functional, and aesthetic results.

METHOD

Describe the surgical technique step by step and analyze 629 surgical treatments. The cohort comprises the period January 2018 to January 2023. Our Database registered 318 men and 311 women who underwent video endoscopicassisted Rives-Stoppa techniques to treat umbilical and epigastric hernias with diastasis RESULTS: All patients were treated on an outpatient basis and discharged home on the same day. The most frequent complications were seromas with conservative management. Other complications recorded were omphalitis in 6 patients, and three patients presented hematomas, one of whom performed surgical evacuation. There were ten patients with recurrences.

CONCLUSION

These hybrid approaches provide the advantages of mini-invasive techniques with a lower rate of complications and a high standard of quality of life, providing anatomical, functional, and aesthetic benefits.

摘要

目的

文献中详细介绍了许多治疗腹疝和腹直肌分离的手术技术,包括传统的和视频内镜的,有或没有网片放置。我们借鉴了 Wolfgang Reinpold(Mini-或 Less Open Sublay Operation,MILOS)和 Federico Fiori(Totally Endoscopic Sublay Anterior Repair,TESAR)提出的一些技术细节,并进行了改良,使用一种后筋膜修补和加强的方法,即在肌肉后放置补片,通过最小的脐部切口实现筋膜的一期关闭,并寻找最佳的解剖学、功能和美学效果。

方法

逐步描述手术技术,并分析 629 例手术治疗。该队列包括 2018 年 1 月至 2023 年 1 月期间的患者。我们的数据库记录了 318 名男性和 311 名女性患者,他们接受了视频内镜辅助的 Rives-Stoppa 技术治疗脐疝和上腹疝合并腹直肌分离。

结果

所有患者均在门诊治疗,当天出院。最常见的并发症是经保守治疗的血清肿。其他记录的并发症包括 6 例脐炎和 3 例血肿,其中 1 例血肿患者需要手术清除。有 10 例患者复发。

结论

这些混合方法结合了微创技术的优势,并发症发生率较低,生活质量较高,同时提供了解剖学、功能和美学方面的益处。

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Hernia. 2024 Dec;28(6):2403-2409. doi: 10.1007/s10029-024-03151-4. Epub 2024 Sep 6.
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本文引用的文献

1
Prevalence and risk factors for diastasis recti abdominis: a review and proposal of a new anatomical variation.腹直肌分离的患病率及危险因素:综述及一种新的解剖变异的提出。
Hernia. 2021 Aug;25(4):883-890. doi: 10.1007/s10029-021-02468-8. Epub 2021 Aug 6.
2
Evolving concepts in ventral hernia repair and physical therapy: prehabilitation, rehabilitation, and analogies to tendon reconstruction.腹外疝修复和物理治疗的概念演变:预康复、康复以及与肌腱重建的类比。
Hernia. 2021 Aug;25(4):1-13. doi: 10.1007/s10029-020-02304-5. Epub 2020 Sep 21.
3
MILOS and EMILOS repair of primary umbilical and epigastric hernias.
MILOS 和 EMILOS 修复脐疝和腹上疝。
Hernia. 2019 Oct;23(5):935-944. doi: 10.1007/s10029-019-02056-x. Epub 2019 Sep 30.
4
Totally Endoscopic Sublay Anterior Repair for Ventral and Incisional Hernias.完全内镜下经肌下前路修补术治疗腹直肌旁疝和切口疝
J Laparoendosc Adv Surg Tech A. 2019 Feb 26. doi: 10.1089/lap.2018.0807.
5
Classification of Rectus Diastasis-A Proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS).腹直肌分离的分类——德国疝学会(DHG)和国际内镜疝学会(IEHS)的提议
Front Surg. 2019 Jan 28;6:1. doi: 10.3389/fsurg.2019.00001. eCollection 2019.
6
Early operative outcomes of endoscopic (eTEP access) robotic-assisted retromuscular abdominal wall hernia repair.内镜(经脐单孔腹腔镜入路)机器人辅助肌后腹壁疝修补术的早期手术结果
Hernia. 2018 Oct;22(5):837-847. doi: 10.1007/s10029-018-1795-z. Epub 2018 Jul 4.
7
A novel approach using the enhanced-view totally extraperitoneal (eTEP) technique for laparoscopic retromuscular hernia repair.一种使用增强型完全腹膜外(eTEP)技术的腹腔镜肌后疝修补的新方法。
Surg Endosc. 2018 Mar;32(3):1525-1532. doi: 10.1007/s00464-017-5840-2. Epub 2017 Sep 15.
8
The general surgeon's perspective of rectus diastasis. A systematic review of treatment options.普外科医生对腹直肌分离的看法。治疗选择的系统评价。
Surg Endosc. 2017 Dec;31(12):4934-4949. doi: 10.1007/s00464-017-5607-9. Epub 2017 Jun 8.
9
Endoscopic mini/less open sublay technique (EMILOS)-a new technique for ventral hernia repair.内镜下迷你/小切口腹膜前修补技术(EMILOS)——一种腹疝修补新技术。
Langenbecks Arch Surg. 2017 Feb;402(1):173-180. doi: 10.1007/s00423-016-1522-0. Epub 2016 Oct 20.
10
Behavior of the Linea Alba During a Curl-up Task in Diastasis Rectus Abdominis: An Observational Study.腹直肌分离患者在卷腹任务中白线的表现:一项观察性研究
J Orthop Sports Phys Ther. 2016 Jul;46(7):580-9. doi: 10.2519/jospt.2016.6536.