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Abstract：
OBJECTIVE: The aim of this study was to compare the likelihood of bowel obstruction according to the placement of the mesh (either intraperitoneal or extraperitoneal) in ventral hernia repairs.
METHODS: Patients were divided into two groups, an intraperitoneal (IP) group (mesh placed by laparoscopy or with an open approach) and an extraperitoneal (EP) group, all operated on in the Digestive Surgery Department at the Dijon University Hospital. The primary outcome was the occurrence of an episode of bowel obstruction requiring hospitalization and confirmed by abdominal CT scan.
RESULTS: Between March 2008 and July 2021, 318 patients were included, with 99 patients in the EP group (71 meshes placed preperitoneally and 28 placed retromuscularly) and 219 patients in the IP group (175 patients operated on laparoscopically versus 44 patients by direct approach). Three patients presented an episode of acute intestinal obstruction, with no difference between the two groups (p = 0.245), although all bowel obstructions occurred in the IP group and with the laparoscopic approach (1.7% of patients operated on by laparoscopy). The occlusive events occurred at 1 month, 2 years, and 3 years. There was no difference in terms of recurrence or postoperative chronic pain. There were more seroma and mesh infections in the EP group (p < 0.05). Two patients operated on by laparoscopy had undetected bowel injuries, prompting emergent surgery for peritonitis.
CONCLUSIONS: No statistically significant difference was found in terms of bowel obstruction between the intraperitoneal and the extraperitoneal position, but all cases of obstruction happened in the intraperitoneal mesh group. Visceral lesions remain a major complication of the laparoscopic approach that should not be neglected.
METHODS: Patients were divided into two groups, an intraperitoneal (IP) group (mesh placed by laparoscopy or with an open approach) and an extraperitoneal (EP) group, all operated on in the Digestive Surgery Department at the Dijon University Hospital. The primary outcome was the occurrence of an episode of bowel obstruction requiring hospitalization and confirmed by abdominal CT scan.
RESULTS: Between March 2008 and July 2021, 318 patients were included, with 99 patients in the EP group (71 meshes placed preperitoneally and 28 placed retromuscularly) and 219 patients in the IP group (175 patients operated on laparoscopically versus 44 patients by direct approach). Three patients presented an episode of acute intestinal obstruction, with no difference between the two groups (p = 0.245), although all bowel obstructions occurred in the IP group and with the laparoscopic approach (1.7% of patients operated on by laparoscopy). The occlusive events occurred at 1 month, 2 years, and 3 years. There was no difference in terms of recurrence or postoperative chronic pain. There were more seroma and mesh infections in the EP group (p < 0.05). Two patients operated on by laparoscopy had undetected bowel injuries, prompting emergent surgery for peritonitis.
CONCLUSIONS: No statistically significant difference was found in terms of bowel obstruction between the intraperitoneal and the extraperitoneal position, but all cases of obstruction happened in the intraperitoneal mesh group. Visceral lesions remain a major complication of the laparoscopic approach that should not be neglected.
摘要：
目的：本研究的目的是根据腹侧疝修补术中网片的放置（腹膜内或腹膜外）比较肠梗阻的可能性。
方法：患者分为两组，腹膜内（IP）组（通过腹腔镜或开放入路放置网状物）和腹膜外（EP）组，全部在第戎大学医院消化外科进行手术。主要结果是发生需要住院治疗的肠梗阻发作，并通过腹部CT扫描证实。
结果：在2008年3月至2021年7月期间，共纳入318例患者，EP组中有99例患者（腹膜前放置71个网状物，肌后放置28个），IP组中有219例患者（腹腔镜手术175例，直接入路手术44例）。3例患者出现急性肠梗阻，两组之间没有差异（p=0.245），尽管所有肠梗阻都发生在IP组和腹腔镜手术组(1.7%的腹腔镜手术患者)。闭塞事件发生在1个月时，2年,和3年。在复发或术后慢性疼痛方面没有差异。EP组血清肿和网状感染较多（p<0.05）。两名通过腹腔镜手术的患者未发现肠损伤，提示腹膜炎的紧急手术。
结论：腹膜内和腹膜外位置的肠梗阻无统计学差异，但所有阻塞病例均发生在腹腔内网眼组。内脏病变仍然是腹腔镜手术的主要并发症，不容忽视。
方法：患者分为两组，腹膜内（IP）组（通过腹腔镜或开放入路放置网状物）和腹膜外（EP）组，全部在第戎大学医院消化外科进行手术。主要结果是发生需要住院治疗的肠梗阻发作，并通过腹部CT扫描证实。
结果：在2008年3月至2021年7月期间，共纳入318例患者，EP组中有99例患者（腹膜前放置71个网状物，肌后放置28个），IP组中有219例患者（腹腔镜手术175例，直接入路手术44例）。3例患者出现急性肠梗阻，两组之间没有差异（p=0.245），尽管所有肠梗阻都发生在IP组和腹腔镜手术组(1.7%的腹腔镜手术患者)。闭塞事件发生在1个月时，2年,和3年。在复发或术后慢性疼痛方面没有差异。EP组血清肿和网状感染较多（p<0.05）。两名通过腹腔镜手术的患者未发现肠损伤，提示腹膜炎的紧急手术。
结论：腹膜内和腹膜外位置的肠梗阻无统计学差异，但所有阻塞病例均发生在腹腔内网眼组。内脏病变仍然是腹腔镜手术的主要并发症，不容忽视。
