Vasile Mihai Alexandru, Cochior Daniel, Ștefanescu Victor, Betianu Cezar, Neagu Andrei, Bucur Alexandru, Turcu Flavia Liliana, Georgescu Dragoş-Eugen, Enciu Octavian, Pã Traşcu Traian
Chirurgia (Bucur). 2025 Jul;120(Ahead of print):1-11. doi: 10.21614/chirurgia.3129.
The objective of this study was to collect and analyze data on patient demographics, lifestyle, abdominal cavity characteristics, and their impact on intra-abdominal pressure before and after minimally invasive treatment of large parietal defects in hernia pathology. Additionally, the study examines the role of the CT scan as a reliable and valid measure of defect and muscle characteristics, which can help establish the indication for performing Transversus Abdominis Release (TAR) and evaluate the outcomes of this procedure along with differences in intra-abdominal pressure (IAP) and plateau pressure (Pplat). This prospective study involved 20 patients with parietal defects wider than 10 cm, treated over four years at the Central Military Hospital in Bucharest. All procedures were performed using the laparoscopic TAR technique by the same surgical team. Preoperative assessments included CT imaging to measure defect size, volumes, and IAP. Data including defect dimensions, muscle measurements, IAP, and Pplat were systematically recorded in a dedicated database with a follow-up at 6 months with clinical and imaging evaluations. In our cohort of 20 patients, all female, the mean BMI was 26.81+-3.05, and the hernia sac volume (HSV) averaged 159.01+-189.79 cm³. The defect area was 69.53 cm² (+-30.11). IAP decreased from 5 cmH2O (+-1.28) preoperatively to 1.91 cmH2O (Ã+-1.93) postoperatively. The reduction in Pplat was similarly significant. Pressure variations were influenced by the topographic location of the defect, with higher pressures seen in epigastric defects, and by the characteristics of the peritoneo-fascial defects, including number, size, and localization, which affect pressure outcomes. Additionally, dimensions of the anterior-lateral abdominal muscles correlated with pressure changes. These findings highlight the importance of comprehensive preoperative assessment of defect characteristics, muscular anatomy, and defect location for predicting pressure reductions and guiding surgical planning. Higher BMI and large, multiple parietal defects predict increased IAP and Pplat postoperatively. Preoperative volumetric and morphometric parameters, defect localization, and topographic characteristics significantly influence pressure outcomes. The TAR technique effectively manages large defects while minimizing pressure increases, but consideration of morphological factors is crucial for optimal results. Further research is needed to refine patient selection and surgical strategies.
本研究的目的是收集和分析有关患者人口统计学、生活方式、腹腔特征的数据，以及这些因素对疝病理中大型腹壁缺损微创治疗前后腹内压的影响。此外，该研究还考察了CT扫描作为一种可靠且有效的测量缺损和肌肉特征的方法的作用，这有助于确定实施腹横肌松解术（TAR）的指征，并评估该手术的效果以及腹内压（IAP）和平台压（Pplat）的差异。这项前瞻性研究纳入了20例腹壁缺损宽度超过10 cm的患者，他们在布加勒斯特中央军事医院接受了为期四年的治疗。所有手术均由同一手术团队采用腹腔镜TAR技术进行。术前评估包括CT成像以测量缺损大小、容积和IAP。包括缺损尺寸、肌肉测量值、IAP和Pplat在内的数据被系统记录在一个专用数据库中，并在6个月时进行临床和影像学评估随访。在我们这组20例均为女性的患者中，平均BMI为26.81±3.05，疝囊容积（HSV）平均为159.01±189.79 cm³。缺损面积为69.53 cm²（±30.11）。IAP从术前的5 cmH2O（±1.28）降至术后的1.91 cmH2O（±1.93）。Pplat的降低同样显著。压力变化受缺损的地形位置影响，上腹部缺损处压力较高，还受腹膜 - 筋膜缺损的特征影响，包括数量、大小和位置，这些都会影响压力结果。此外，腹外侧肌的尺寸与压力变化相关。这些发现凸显了对缺损特征、肌肉解剖结构和缺损位置进行全面术前评估对于预测压力降低和指导手术规划的重要性。较高的BMI以及大型、多发的腹壁缺损预示着术后IAP和Pplat会升高。术前的容积和形态学参数、缺损位置以及地形特征会显著影响压力结果。TAR技术能有效处理大型缺损，同时将压力升高降至最低，但考虑形态学因素对于获得最佳效果至关重要。需要进一步研究以优化患者选择和手术策略。
