Division of General Surgery, New York University Langone Health, 550 First Ave, New York City, NY, 10016, USA.
Minimally Invasive Surgery Department, Nossa Semhora das Graças Hospital, Curitiba, Brazil.
Updates Surg. 2024 Nov;76(7):2715-2722. doi: 10.1007/s13304-024-02002-2. Epub 2024 Sep 19.
Transabdominal preperitoneal (TAPP) ventral hernia repair requires incising the peritoneum from within the abdominal cavity, developing a flap, and placing a reinforcing mesh after fascial closure from the preperitoneal space. We present a novel adaptation to this technique that allows placement of preperitoneal mesh without entering the abdominal cavity. The robotic totally extra- and preperitoneal (R-PeTEP) access for ventral hernia repair is best suited for small to moderate sized ventral hernias with concomitant diastasis recti.
Our study is a retrospective review of all patients who underwent R-PeTEP from December 2022 to November 2023. A comprehensive description of the surgical technique is included. Patient demographics, hernia characteristics, as well as clinical outcomes are described.
A total of 25 patients underwent R-PeTEP for ventral hernia repair with diastasis recti plication. The median age was 55 years (IQR 43.5-63) and 92% (n = 23) were male. The median ASA score was 2 (IQR 1-2) and the median BMI was 30.4 (IQR 29.3-32.8) with 64% (n = 16) percent having a BMI ≥ 30. Median hernia width was 3 cm (IQR 3-4), with a median diastasis recti width of 4 cm (IQR 2.6-4) and length of 15 cm (IQR 11.8-16). The median operative time was 120 min (IQR 116-134). All repairs were reinforced with permanent mesh. Sixty-eight percent of the patients (n = 17) were discharged on the same day. With a median follow-up of 30 days (IQR 16-107), 8% (n = 2) seromas, 16% (n = 4) developed clinically insignificant hematomas, and one patient (4%) developed ileus that was managed conservatively.
This study establishes the feasibility and safety of R-PeTEP, which provides direct access to the preperitoneal space, avoiding disruption to the posterior rectus sheath, possibly reducing neurovascular bundle injuries, and omitting entry to the abdominal cavity. R-PeTEP facilitates wide flap creation for prosthetic overlap and allows for posterior plication of diastasis recti with little to no mesh fixation with overall excellent preliminary clinical outcomes.
经腹腹膜前（TAPP）腹疝修补术需要从腹腔内切开腹膜，形成皮瓣，并在从腹膜前间隙进行筋膜闭合后放置增强网。我们提出了一种该技术的新方法，允许在不进入腹腔的情况下放置腹膜前网。机器人完全腹膜外和前腹膜（R-PeTEP）腹疝修补术最适合伴有腹直肌分离的小至中等大小的腹疝。
我们的研究是对 2022 年 12 月至 2023 年 11 月期间接受 R-PeTEP 治疗的所有患者进行的回顾性分析。包括手术技术的全面描述。描述了患者的人口统计学、疝特征以及临床结果。
共有 25 例患者因腹直肌分离行 R-PeTEP 腹疝修补术。中位年龄为 55 岁（IQR 43.5-63），92%（n=23）为男性。中位 ASA 评分为 2 分（IQR 1-2），中位 BMI 为 30.4（IQR 29.3-32.8），64%（n=16）的 BMI≥30。中位疝宽 3cm（IQR 3-4），腹直肌分离宽 4cm（IQR 2.6-4），长 15cm（IQR 11.8-16）。中位手术时间为 120 分钟（IQR 116-134）。所有修复均采用永久性网片加固。68%的患者（n=17）当天出院。中位随访 30 天（IQR 16-107），8%（n=2）出现血清肿，16%（n=4）出现临床意义较小的血肿，1 例（4%）发生肠梗阻，经保守治疗。
本研究确立了 R-PeTEP 的可行性和安全性，它提供了直达腹膜前间隙的通道，避免了对后直肌鞘的破坏，可能减少了神经血管束损伤，并省略了进入腹腔的步骤。R-PeTEP 有利于广泛的皮瓣形成，便于对腹直肌分离进行后修补，并且几乎不需要网片固定，整体临床效果良好。
