Mahmood Sarah, Moollan Yusuf, Badiani Sarit S, Berney Christophe R
Department of Surgery, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia.
Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia.
Front Surg. 2025 Jun 18;12:1575403. doi: 10.3389/fsurg.2025.1575403. eCollection 2025.
There are two conventional approaches to abdominal wall hernia repairs that aim to achieve anatomical restoration. Open approaches have the advantage of complete hernial sac excision with freedom of mesh placement. In comparison, the advantages of the laparoscopic approach involve shorter hospital stays, less postoperative pain, and fewer postoperative complications. More recently, the hybrid approach, which combines the two techniques, has gained popularity as a way to potentially reap the benefits of both. Our aim was to determine whether this hybrid approach can achieve the same benefits, irrespective of hernia size, age, and body mass index (BMI). Primary outcome of interest was hernia recurrence. Secondary outcomes included postoperative complications, pain, and quality of life (QoL).
Medical records of all patients who underwent hybrid laparoscopic hernia repair (HLHR) with transabdominal partially extraperitoneal (TAPE) mesh fixation between 2017 and 2023 were retrieved from a prospectively maintained institutional database and retrospectively analyzed. Intra- and postoperative complications, as well as hernia recurrence, were recorded. QoL was assessed using the Carolinas Comfort Scale (CCS).
There were 37 patients (21 women, 56.8%) with a mean age of 66 years and BMI of 34.2 kg/m who underwent hybrid hernia repair. Of them, 34 (91.9%) were incisional hernias, of which 50% were recurrent. Mean hernia defect size was 96.8 cm. Of the patients, 12 (32.4%) received preoperative chemical component separation with botulinum toxin A (BTA); this group had a significantly higher BMI and hernia size compared to the no BTA group (37.7 vs. 32.5; = 0.048; 174.5 cm vs. 59.5 cm; = 0.0002). There were no intraoperative complications; however, there were 8 (21.6%) minor postoperative complications. After a mean follow-up of 40 months, we recorded one hernia recurrence at 23 months postoperatively (2.7%). In addition, out of 29 (78.4%) patients assessed for QoL, the median and mean scores were reported as 0 out of 115 and 2.6 out of 115 points scale, respectively.
HLHR with TAPE mesh fixation is safe, with satisfactory mid- to long-term outcomes, irrespective of hernia size and BMI.
腹壁疝修补有两种传统方法，旨在实现解剖复位。开放手术的优点是能完整切除疝囊，且可自由放置补片。相比之下，腹腔镜手术的优点包括住院时间短、术后疼痛轻和术后并发症少。最近，结合这两种技术的杂交手术作为一种可能同时获得两种手术益处的方法而受到欢迎。我们的目的是确定这种杂交手术是否能在不考虑疝大小、年龄和体重指数（BMI）的情况下获得相同的益处。主要关注的结局是疝复发。次要结局包括术后并发症、疼痛和生活质量（QoL）。
从一个前瞻性维护的机构数据库中检索2017年至2023年间接受经腹部分腹膜外（TAPE）补片固定的杂交腹腔镜疝修补术（HLHR）的所有患者的病历，并进行回顾性分析。记录术中及术后并发症以及疝复发情况。使用卡罗来纳舒适度量表（CCS）评估生活质量。
37例患者（21例女性，占56.8%）接受了杂交疝修补术，平均年龄66岁，BMI为34.2kg/m。其中，34例（91.9%）为切口疝，其中50%为复发性疝。平均疝缺损大小为96.8cm。12例（32.4%）患者术前接受了肉毒杆菌毒素A（BTA）化学组分分离；与未使用BTA的组相比，该组的BMI和疝大小显著更高（37.7对32.5；P = 0.048；174.5cm对59.5cm；P = 0.0002）。无术中并发症；然而，有8例（21.6%）轻微术后并发症。平均随访40个月后，我们记录到1例术后23个月疝复发（2.7%）。此外，在29例（78.4%）接受生活质量评估的患者中，中位数和平均得分分别报告为115分制中的0分和2.6分。
采用TAPE补片固定的HLHR是安全的，无论疝大小和BMI如何，中长期结局均令人满意。
