Canton Silvio Alen, Valmasoni Michele
Department of Surgery, Oncology and Gastroenterology (DiSCOG), University of Padua, Padua, Italy.
JSLS. 2025 Jan-Mar;29(1). doi: 10.4293/JSLS.2024.00072. Epub 2025 Apr 1.
In 2009, we designed the sutureless "Slim-Mesh" laparoscopic technique to facilitate and promote repair of ventral hernias in the obese/superobese populations, including cases with large-giant/massive and multiple widely-spaced hernias. We also aimed to reduce surgical time and intra- and postoperative complications.
Cases were divided into Class I (body mass index [BMI] 30.0-34.9 kg/m), II (35.0-39.9 kg/m), III (40.0-49.9 kg/m), and superobese (50.0-59.9 kg/m). A ventral hernia was small-medium (∅ 2-9.9 cm), or large (∅ 10-14.9 cm)-giant (∅ 15-19.9 cm)/massive (∅ ≥ 20 cm). Between September 2009 and May 2023, 64 obese/superobese ventral-hernia patients were enrolled prospectively (81%)-retrospectively and treated with the Slim-Mesh technique.
We operated on 35 males and 29 females. Mean age and BMI were 60 years old and 33 kg/m, respectively. Class I cases numbered 48, II 13, III 2, with 1 superobese case. Small-medium, large-giant, and massive ventral hernias were found intraoperatively in 40, 21, and 3 cases, respectively. Mean surgical time for all cases was 104 minutes. Mean length of hospital stay was 2 days and mean follow-up time was 5 years. We had 1 case of chronic abdominal-wall pain and 6 late postoperative-complications: 4 (6%) hernia recurrences, and 2 trocar-site hernias.
The sutureless "Slim-Mesh" technique implements the laparoscopic approach to repair ventral hernias in the obese/superobese populations rather than open surgery or traditional transfixation suture-based laparoscopy, including cases with large-giant/massive and multiple widely-spaced hernias. This study proves that "Slim-Mesh" is safe, straightforward, quick, easy-to-reproduce, and economical.
2009年，我们设计了无缝合“细网”腹腔镜技术，以便利和促进肥胖/超级肥胖人群腹疝的修复，包括大型/巨大型和多个间距较大的疝病例。我们还旨在减少手术时间以及术中与术后并发症。
病例分为I级（体重指数[BMI] 30.0 - 34.9 kg/m²）、II级（35.0 - 39.9 kg/m²）、III级（40.0 - 49.9 kg/m²）和超级肥胖级（50.0 - 59.9 kg/m²）。腹疝为小中型（直径2 - 9.9 cm）、大型（直径10 - 14.9 cm）、巨大型（直径15 - 19.9 cm）或巨型（直径≥20 cm）。2009年9月至2023年5月，64例肥胖/超级肥胖腹疝患者被前瞻性（81%）-回顾性纳入并采用细网技术治疗。
我们为35名男性和29名女性进行了手术。平均年龄和BMI分别为60岁和33 kg/m²。I级病例48例，II级13例，III级2例，超级肥胖级1例。术中发现小中型、大型/巨大型和巨型腹疝分别为40例、21例和3例。所有病例的平均手术时间为104分钟。平均住院时间为2天，平均随访时间为5年。我们有1例慢性腹壁疼痛和6例术后晚期并发症：4例（6%）疝复发，2例套管针部位疝。
无缝合“细网”技术采用腹腔镜方法修复肥胖/超级肥胖人群的腹疝，而非开放手术或传统的基于贯穿缝合法的腹腔镜手术，包括大型/巨大型和多个间距较大的疝病例。本研究证明“细网”技术安全、直接、快速、易于复制且经济。
