Abstract：
Background: Complex ventral hernia remains a challenging situation for any surgeon. In this study, our aim was to analyze the effect of laparoscopic intraperitoneal onlay mesh (IPOM) repair in the treatment of complex abdominal wall hernia, with the assistance of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA). Methods: In this retrospective study, we included 13 patients with complex ventral hernia between May 2021 and December 2022. All patients undergoing PPP and BTA protocol before hernia repair. The length of abdominal wall muscles and abdominal circumference were measured from CT scan. All hernias were repaired with laparoscopic or laparoscopic-assisted IPOM. Results: Thirteen patients received PPP and BTA injections. PPP and BTA administration time was over 8.8 ± 2.5 days. Before and after PPP and BTA, imaging showed that the length of lateral muscle on each side increased from 14.3 to 17.4 cm (P < .05). The abdominal circumference increased from 81.8 to 87.9 cm (P < .05). Complete fascial closure was obtained in 13 patients (100%), and no patient experienced postoperative abdominal hypertension and ventilatory support. No patient suffered from recurrent hernia to date. Conclusions: Preoperative PPP combined with BTA injection plays a role similar to component separation technique, avoids the abdominal hypertension after laparoscopic IPOM repair of complex ventral hernia.
摘要：
背景：对于任何外科医生来说，复杂的腹侧疝仍然是一个具有挑战性的情况。在这项研究中,我们的目的是分析腹腔镜腹膜内嵌网（IPOM）修补术治疗复杂性腹壁疝的效果，在术前进行性气腹（PPP）和肉毒杆菌毒素A（BTA）的协助下。方法：在这项回顾性研究中，我们纳入了2021年5月至2022年12月期间的13例复杂性腹疝患者.所有患者在疝修补术前接受PPP和BTA方案。通过CT扫描测量腹壁肌肉的长度和腹围。所有疝均采用腹腔镜或腹腔镜辅助IPOM修复。结果：13例患者接受了PPP和BTA注射。PPP和BTA给药时间超过8.8±2.5天。在PPP和BTA之前和之后，影像学显示两侧外侧肌的长度从14.3cm增加到17.4cm(P<.05)。腹围从81.8cm增加到87.9cm(P<.05)。13例患者（100%）获得完全筋膜闭合，没有患者出现术后腹部高血压和通气支持。迄今为止，没有患者患有复发性疝气。结论:术前PPP联合BTA注射起到类似成分分离技术的作用,避免了腹腔镜下复杂腹侧疝IPOM修补术后的腹腔高压。
