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慢性肾衰竭患者腹腔镜下腹壁疝修补术与腹膜透析导管置入术同期进行:单中心回顾性分析

Simultaneous Laparoscopic Ventral Hernia Repair and Peritoneal Dialysis Catheter Placement in Patients With Chronic Renal Failure: A Single-Center Retrospective Analysis.

作者信息

Marte Gianpaolo, Surfaro Giuseppe, Argentino Gennaro, Camocardi Andrea, Guida Francesco, Genualdo Raffaele, Armellino Mariano F

机构信息

Department of General Surgery, Ospedale del Mare, Naples, ITA.

Department of Nephrology and Dialysis, Ospedale del Mare, Naples, ITA.

出版信息

Cureus. 2025 May 5;17(5):e83521. doi: 10.7759/cureus.83521. eCollection 2025 May.

Abstract

Background In patients undergoing peritoneal dialysis (PD), there is a high incidence of ventral hernia during the first five years of follow-up. Early diagnosis of the occurrence of ventral hernias in PD patients is very important to ensure their surgical treatment as quickly as possible. Methods A retrospective analysis of prospectively collected data was conducted between January 2022 and May 2023. All patients who have undergone peritoneal catheter implantation by laparoscopy and concomitant ventral hernia repair according to the laparoscopic intra-peritoneal onlay mesh technique were enrolled. Primary outcomes include operative time, blood loss volume, conversion to open surgery, hospital stay, hematoma, chronic pain, complication rate according to Clavien Dindo score, hernia recurrences, and peritoneal catheter displacement or malfunction. Results The mean operative time was 40 minutes (range: 30-60 minutes). Intraoperative blood loss was less than 30 ml. No conversion to laparotomy was needed. Considering a mean follow-up of six months, no Clavien Dindo grade > 2 was recorded. One hematoma appeared on postoperative day 4. No chronic pain, defined as pain lasting >3 months, was recorded. No hernia recurrence was registered, but one was an asymptomatic bulging Early initiation of PD was achieved, with no reported malfunctions of the peritoneal catheter or infusion system to date. Conclusion For patients on PD with ventral hernia, laparoscopic intraperitoneal onlay mesh (IPOM)repair has the advantages of less trauma, simultaneous treatment of occult hernias, adjustment and fixation of PD tubes, low incision complication rates, and low recurrence rates. IPOM repair can be performed safely and effectively in this population group; thus, it is a procedure worth promoting.

摘要

背景

在接受腹膜透析(PD)的患者中,随访的前五年腹疝发生率很高。早期诊断PD患者腹疝的发生对于确保尽快进行手术治疗非常重要。方法:对2022年1月至2023年5月前瞻性收集的数据进行回顾性分析。纳入所有通过腹腔镜进行腹膜导管植入并根据腹腔镜腹腔内补片修补技术同时进行腹疝修补的患者。主要结局包括手术时间、失血量、转为开放手术、住院时间、血肿、慢性疼痛、根据Clavien Dindo评分的并发症发生率、疝复发以及腹膜导管移位或故障。结果:平均手术时间为40分钟(范围:30 - 60分钟)。术中失血量少于30毫升。无需转为剖腹手术。考虑到平均随访6个月,未记录到Clavien Dindo分级>2级的情况。术后第4天出现1例血肿。未记录到定义为持续>3个月疼痛的慢性疼痛。未记录到疝复发,但有1例为无症状隆起。实现了PD的早期启动,迄今为止未报告腹膜导管或输液系统故障。结论:对于患有腹疝的PD患者,腹腔镜腹腔内补片修补(IPOM)具有创伤小、隐匿疝同步治疗、PD管调整和固定、切口并发症发生率低以及复发率低等优点。IPOM修补术可在该人群中安全有效地进行;因此,这是一种值得推广的手术。

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