PDF(Pubmed)
Abstract：
Pelvic floor hernias represent a rare type of hernia and a rare etiology of pelvic symptoms. The rarest type of pelvic floor hernias are sciatic hernias, which present with a variety of symptoms depending on the hernia contents and location. Many different treatment approaches are described in the literature. A 73-year-old female presented to our outpatient minimally invasive surgery (MIS) clinic with one year of colicky left flank pain. She had previously presented to an emergency department, at which time a computed tomography (CT) scan demonstrated left-sided hydronephrosis in the setting of a left-sided ureterosciatic hernia. She was asymptomatic and had no palpable hernia bulge. An operative repair was offered based on her prolonged symptoms. The patient was brought electively to the operating room with minimally invasive and urological surgeons. A left ureteral stent was placed over a guidewire. A robotic repair was performed with a round piece of biosynthetic mesh, secured in place with fibrin glue. Sciatic hernias are an extremely rare etiology of pelvic symptoms and require a high index of suspicion to identify. Obstructive and neuropathic symptoms may be intermittent, so diagnosis is often made using CT imaging. We report a successful treatment with pre-operative ureteral stenting followed by a robotic repair using biologic mesh secured with fibrin glue fixation. We believe this is a durable repair although acknowledge that longer follow-up is needed to establish the longevity of our treatment modality.
摘要：
盆底疝代表罕见类型的疝和罕见的盆腔症状病因。最罕见的盆底疝是坐骨疝,根据疝内容物和位置的不同，会出现各种症状。文献中描述了许多不同的治疗方法。一位73岁的女性出现在我们的门诊微创手术（MIS）诊所，患有一年的左侧腹部疼痛。她以前去过急诊室，此时，计算机断层扫描（CT）扫描显示左侧输尿管坐骨神经疝的左侧肾积水。她无症状，没有明显的疝气隆起。根据她的长期症状提供了手术修复。患者被选择性地带到手术室与微创和泌尿外科医生。将左输尿管支架放置在导丝上。用一块圆形的生物合成网进行了机器人修复，用纤维蛋白胶固定到位。坐骨神经疝是盆腔症状的极为罕见的病因，需要高度怀疑才能识别。阻塞性和神经性症状可能是间歇性的，所以诊断通常使用CT成像。我们报告了成功的术前输尿管支架置入术，然后使用纤维蛋白胶固定的生物网状物进行机器人修复。我们认为这是一种持久的修复，尽管我们承认需要更长的随访才能确定我们治疗方式的寿命。
