目的:虽然关于腹股沟疝的研究有很好的记录,腹侧/切口疝仍需检查。在印度,关于腹腔镜腹侧疝修补术(LVHR)技术的观点存在争议。目前的共识旨在标准化LVHR实践,并确定损害患者安全和治疗结果的差距和未满足的需求。
方法:使用改进的Delphi技术,由14名专家(普通外科医生)组成的小组达成了共识。在网上进行了两轮共识。举行了第三轮顾问委员会会议,其中讨论了调查结果,并在支持临床证据的情况下决定了最终陈述。
结果:专家建议腹膜内覆盖网片(IPOM)加/经腹后肌层/扩展完全腹膜外/小型或较少开放的覆盖手术/经腹腹膜前/经腹部分腹膜外/皮下覆盖腹腔镜入路/腹腔镜内直肌筋膜成形术(MAS)作为腹侧VH(疝气)的有效微创手术(MAS)选择。腹膜内修补技术是首选的MAS手术,治疗原发性脐疝<4cm,无扩张;切口疝存在垂直单中线切口;有症状的疝,BMI>40kg/m2,并且缺损高达4cm;并且对于具有3/4级美国麻醉医师协会的MASVH手术。IPOMplus是先前开腹手术患者中宽度<4cm的中线切口疝的首选MAS手术。对于L3疝<4cm;中线疝<4cm伴扩张;和M5疝,腹膜外修复技术是首选的MAS手术。
结论:共识声明将有助于规范LVHR实践,改善决策,并为印度方案中的VHR中的MAS提供指导。
OBJECTIVE: While research on inguinal hernias is well-documented, ventral/incisional hernias still require investigation. In India, opinions on
laparoscopic ventral hernia repair (LVHR) techniques are contested. The current
consensus aims to standardize LVHR practice and identify gaps and unfulfilled demands that compromise patient safety and therapeutic outcomes.
METHODS: Using the modified Delphi technique, panel of 14 experts (general surgeons) came to a consensus. Two rounds of
consensus were conducted online. An advisory board meeting was held for the third round, wherein survey results were discussed and the final statements were decided with supporting clinical evidence.
RESULTS: Experts recommended intraperitoneal onlay mesh (IPOM) plus/trans-abdominal retromuscular/extended totally extraperitoneal/mini- or less-open sublay operation/transabdominal preperitoneal/trans-abdominal partial extra-peritoneal/subcutaneous onlay
laparoscopic approach/
laparoscopic intracorporeal rectus aponeuroplasty as valid minimal access surgery (MAS) options for ventral hernia (VH). Intraperitoneal repair technique is the preferred MAS procedure for primary umbilical hernia < 4 cm without diastasis; incisional hernia in the presence of a vertical single midline incision; symptomatic hernia, BMI > 40 kg/m2, and defect up to 4 cm; and for MAS VH surgery with grade 3/4 American Society of Anaesthesiologists. IPOM plus is the preferred MAS procedure for midline incisional hernia of width < 4 cm in patients with a previous laparotomy. Extraperitoneal repair technique is the preferred MAS procedure for L3 hernia < 4 cm; midline hernias < 4 cm with diastasis; and M5 hernia.
CONCLUSIONS: The consensus statements will help standardize LVHR practices, improve decision-making, and provide guidance on MAS in VHR in the Indian scenario.