背景:本文旨在分享腹膜前eTEP方法的初步经验及其在选定的一组患者中的潜在益处。eTEPRives-Stoppa是一种经过验证的微创手术技术,用于治疗腹侧中线和非中线疝,耐用,和可重复的修复。腹膜前eTEP修复是一种手术技术,可将腹膜外入路手术与腹膜前修复结合起来,用于原发性中线疝,避免了后直肌鞘分裂和保留直肌后间隙,同时能够治疗直肌同时舒张。
方法:分析包括2022年9月至2023年9月采用腹膜前eTEP方法手术的33例原发性小到中(<4cm)中线疝患者,有或没有直肠舒张的单个或多个缺陷。年龄,性别,疝的特点,手术时间,将讨论手术部位的发生,以及手术技术中的细节和地标。
结果:连续33例患者接受了手术,年龄在32至63岁之间的19名女性(57.5%)和14名男性(42.5%),最常见的合并症是肥胖(BMI>30).在70%的案例中,手术时间为90min±25min。平均住院时间是一天,而12人在同一天回家,到目前为止,没有复发的报道。
结论:我们相信腹膜前eTEP方法治疗中小型原发性中线疝是一种有效而坚固的修复方法,它结合了成熟的手术技术的优良特征,消除了对后直肌鞘的分割,同时节省了后直肌空间,其他的好处将被讨论。该技术的可重复性仍有待证明。
BACKGROUND: This article aims to share the initial experience of the preperitoneal eTEP approach and its potential benefits in a selected group of patients. The eTEP Rives-Stoppa is a proven minimally invasive surgical technique for the treatment of ventral midline and off-midline hernias that has shown to be a solid, durable, and reproducible repair. The preperitoneal eTEP repair is a surgical technique that brings together the extraperitoneal access surgery with a preperitoneal repair for primary midline hernias avoiding posterior rectus sheath division and preservation of the retrorectus space while being able to treat simultaneous diastasis recti.
METHODS: The analysis included 33 patients operated with the preperitoneal eTEP approach from September 2022 to September 2023 in patients with primary small to medium (< 4 cm) midline hernias, single or multiple defects with or without diastasis recti. Age, gender, hernia characteristics, operative time, and surgical site occurrences will be discussed, as well as fine details and landmarks in the operative technique.
RESULTS: 33 consecutive patients were operated, 19 female (57.5%) and 14 males (42.5%) between 32 and 63 years of age, the most common comorbidity found was obesity (BMI > 30). In 70% of the cases, operative time was 90 min ± 25 min. The average hospital stay was one day, while 12 went home the same day, and so far, no reoccurrences have been reported.
CONCLUSIONS: We believe the preperitoneal eTEP approach for small to medium primary midline hernias is an effective and solid repair that combines excellent features of proven surgical techniques and eliminates the need for posterior rectus sheath division while saving the retrorectus space, among other benefits that will be discussed. The reproducibility of the technique remains to be proven.