背景:大型腹壁疝通常需要壁扩张技术来改善手术效果。腹膜瓣疝修补术(PF)是一种利用疝囊重建腹壁的技术,然而,发布的数据有限。这是Rives-Stoppa网片修复的一种改进,其中一部分平分的疝囊用于重建前筋膜,另一部分用于后筋膜。我们对复杂腹侧疝患者进行有或没有腹横肌释放(TAR)的三个中心的结果进行了回顾性分析。
方法:对切口疝患者进行PF,中线和横向。测量的主要结果是疝复发。次要结果是评估疼痛,手术部位感染,血清肿,血肿,伤口裂开,假性复发,Clavien-Dindo并发症评分,和患者报告的生活质量。在随访期间通过口服问卷评估生活质量。
结果:我们分析了63例患者(38例女性,25名男性),疝缺损的平均宽度为11cmSD4。根据欧洲疝学会(EHS)分类,42例患者为W3,21例为W2疝。50个病人有中线疝,而其余的患者包括横纹肌,肋下,和屋顶切口疝。在29例(46%)患者中进行了经典的腹膜瓣手术,34例(54%)患者进行了TAR腹膜瓣。4例患者出现有症状的血清肿(6%),7例浅表手术部位感染(SSI)(11%),一个深度SSI(1.5%),1例皮肤坏死(1.5%),腹膜前皮瓣坏死1例(1.5%)。没有患者需要术后通气支持。第一天的平均疼痛评分为3/10。在平均17个月(5至49个月)的随访中没有复发。总的来说,63例患者中有58例(92%)报告对他们的手术感到满意。
结论:在我们的多中心研究中,我们发现,无论有无TAR的PF技术治疗中线和非中线腹侧疝均可在低复发方面获得满意的结果,并发症发生率低,以及中长期的良好生活质量。在外科医生的医疗设备中,这似乎是一种有用的技术,可以修复需要腹域扩张的W2和W3疝。
BACKGROUND: Large abdominal wall hernias often require techniques for wall expansion to improve surgical outcomes. The peritoneal flap hernioplasty (PF) is one such technique that utilizes the hernia sac to reconstruct the abdominal wall, however, with limited published data. It is a modification of the Rives-Stoppa mesh repair where a part of the bisected hernia sac is utilized to reconstruct the anterior fascia and the other part for the posterior fascia. We present a collated retrospective analysis of the outcomes from three centers performing PF with or without transverse abdominis release (TAR) in patients with complex ventral hernias.
METHODS: The PF was performed in patients with incisional hernias, both midline and lateral. The primary outcome measured was hernia recurrence. The secondary outcomes were to evaluate pain, surgical site infection, seroma, hematoma, wound dehiscence, pseudo-recurrence, Clavien-Dindo score for complications, and the patient\'s reported quality of life. The quality of life was assessed by oral questionnaires in the follow-up period.
RESULTS: We analyzed 63 patients (38 female, 25 male) with a mean width of hernia defect of 11 cm SD 4. Based on the European Hernia Society (EHS) classification 42 patients were W3 and 21 were W2 hernias. Fifty patients had a midline hernia, while the rest of the patients included transverse, subcostal, and rooftop incision hernias. The classical peritoneal flap procedure was done in 29 (46%) patients, while the peritoneal flap with TAR was done in 34 (54%) patients. Four patients had symptomatic seroma (6%), seven superficial surgical site infection (SSI) (11%), one deep SSI (1.5%), one skin necrosis (1.5%), and one anterior peritoneal flap necrosis (1.5%). No patient required postoperative ventilatory support. The mean pain score on day one was 3/10. There was no recurrence in the mean follow-up of 17 months (range 5 to 49 months). Overall, 58 of 63 (92%) patients reported being satisfied with their surgery.
CONCLUSIONS: In our multicentre study, we found the PF technique with or without TAR for midline and non-midline ventral hernia leads to satisfactory outcomes in terms of low recurrence, low rate of complications, and a good quality of life in the medium to long term. It appears to be a useful technique in the surgeon\'s armamentarium to repair W2 and W3 hernias needing expansion of abdominal domain.