微小切口开放腹膜前手术在腹壁疝修补中的临床应用
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摘要
目的探讨微小切口开放腹膜前(mini/lessopensublay,MILOS)手术在腹壁疝修补中的临床应用和效果。方法回顾性分析2016年11月至2018年6月,浙江大学医学院附属杭州市第一人民医院连续收治并接受MILOS手术修补的49例腹壁疝患者。结果平均腹壁缺损宽度(5.27±2.95)cm,平均切口长度(4.89±2.13)cm。36例为切口疝,13例为脐疝(其中3例合并腹直肌分离症)。所有患者均采用MILOS手术完成修补,于肌后、腹膜前间隙放置补片,并放置密闭式负压引流管。平均手术时间(114.2±48.8)min,术中出血量(88.7±38.5)ml,住院时间(10.6±2.4) d。术后有2例(4.1%)浅表手术部位感染,1例(2.0%)Ⅲ型血清肿,均经非手术治疗后治愈。无肠梗阻、补片感染、肠瘘、慢性疼痛等并发症。随访期间未发现有复发、腹壁膨出病例。结论 MILOS手术是一种适应症较广的腹壁疝微创腹膜前修补方式,具有较高的临床应用价值。
Objective To investigate the clinical utility and outcomes of mini/less open sublay(MILOS) approach in ventral hernia repair. Methods Retrospectively studied Forty-nine cases of ventral hernia patients admitted to Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine from November 2016 to June 2018. Clinical materials were collected and analyzed. Results Mean width of abdominal defect were(5.27±2.95) cm. Mean length of incisions were(4.89±2.13) cm. Thirty-six cases were incisional hernia, and thirteen cases were umbilical hernias(with 3 cases combined with diastasis recti abdominis). All the patients underwent MILOS surgery with retro-muscular/preperitoneal mesh reinforcement. Closed suction drains were routinely placed above the mesh. The operation time was(114.2±48.8) minutes, and estimated blood loss was(88.7±38.5) cm3. Length of hospitalization were(10.6±2.4) days. We had 2 cases of superficial SSI and 1 case of grade Ⅲ seroma which were cured under non-surgical therapy. No complications like mesh infection, intestinal obstructions, fistula or chronic pain were reported. No recurrence, or postoperative bulging were reported during the follow-up. Conclusion MILOS approach is a minimal invasive sublay repair with wide indications for ventral hernia repair, which worth utilizing in clinical practicing.
Objective To investigate the clinical utility and outcomes of mini/less open sublay(MILOS) approach in ventral hernia repair. Methods Retrospectively studied Forty-nine cases of ventral hernia patients admitted to Affiliated Hangzhou First People's Hospital of Zhejiang University School of Medicine from November 2016 to June 2018. Clinical materials were collected and analyzed. Results Mean width of abdominal defect were(5.27±2.95) cm. Mean length of incisions were(4.89±2.13) cm. Thirty-six cases were incisional hernia, and thirteen cases were umbilical hernias(with 3 cases combined with diastasis recti abdominis). All the patients underwent MILOS surgery with retro-muscular/preperitoneal mesh reinforcement. Closed suction drains were routinely placed above the mesh. The operation time was(114.2±48.8) minutes, and estimated blood loss was(88.7±38.5) cm3. Length of hospitalization were(10.6±2.4) days. We had 2 cases of superficial SSI and 1 case of grade Ⅲ seroma which were cured under non-surgical therapy. No complications like mesh infection, intestinal obstructions, fistula or chronic pain were reported. No recurrence, or postoperative bulging were reported during the follow-up. Conclusion MILOS approach is a minimal invasive sublay repair with wide indications for ventral hernia repair, which worth utilizing in clinical practicing.
引文
[1]Bittner R,Bingener-Casey J,Dietz U,et al.Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias(International Endohernia Society(IEHS))-part 1[J].Surg Endosc,2014,28(1):22-29.
[2]Chalabi H,Larkin J,Mehigan B,et al.A systematic review of laparoscopic versus open abdominal incisional hernia repair,with meta-analysis of randomized controlled trials[J].Int J Surg,2015,20:65-74.
[3]Awaiz A,Rahman F,Hossain MB,et al.Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia[J].Hernia,2015,19(3):449-463.
[4]Arita NA,Nguyen MT,Nguyen DH,et al.Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias[J].Surg Endosc,2015,29(7):1769-1780.
[5]Sauerland S,Walgenbach M,Habermalz B,et al.Laparoscopic versus open surgical techniques for ventral or incisional hernia repair[J].Cochrane Database Syst Rev,2011,16(3):CD007781.
[6]Bittner R,Bingener-Casey J,Dietz U,et al.Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias(International Endohernia Society[IEHS])-PartⅡ[J].Surg Endosc,2014,28(2):353-379.
[7]Bittner R,Bingener-Casey J,Dietz U,et al.Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias(International Endohernia Society[IEHS])-Part III[J].Surg Endosc,2014,28(2):380-404.
[8]Liang MK,Holihan JL,Itani K,et al.Ventral hernia management:expert consensus guided by systematic review[J].Ann Surg,2017,265(1):80-89.
[9]Rives J,Pire JC,Flament JB,et al.Treatment of large eventrations(apropos of 133 cases)[J].Minerva Chir,1977,32(11):749-756.
[10]Stoppa R,Warlaumont C,Chantriaux JF.Prosthetic surgical treatment of inguinal hernias.Parietalization of the spermatic cord[J].Presse Med,1984,13(38):2317-2318.
[11]Stoppa R,Rives J,Warlaumont C,et al.The use of Dacron in the repair of hernias of the groin[J].Surg Clin North Am,1984,64(2):269-285.
[12]Conze J,Binneb?sel M,Junge K,et al.Incisional hernia-how do I do it?Standard surgical approach[J].Chirurg,2010,81(3):192-200.
[13]Muysoms FE,Miserez M,Berrevoet F,et al.Classification of primary and incisional abdominal wall hernias[J].Hernia,2009,13(4):407-414.
[14]Amid PK,Lichtenstein IL.Retromuscular alloplasty of large scar hernias:a simple staple attachment technique[J].Chirurg,1996,67(6):648-652.
[15]Reinpold W.Neue Techniken in der Narben-und Bauchwandhernienchirurgie[J].Chirurgische Allgemeine,2013,14:331-337.
[16]Schwarz J,Reinpold W,Bittner R.Endoscopic mini/less open sublay technique(EMILOS)-a new technique for ventral hernia repair[J].Langenbecks Arch Surg,2017,402(1):173-180.
[17]Reinpold W,Schr?der M,Berger C,,et al.Mini-or Less-open Sublay Operation(MILOS):A New Minimally Invasive Technique for the Extraperitoneal Mesh Repair of Incisional Hernias[J].Ann Surg,2018,16.
[18]Morales-Conde S.A new classification for seroma after laparoscopic ventral hernia repair[J].Hernia,2012,16(3):261-267.
[19]王平.腹腔镜腹部疝修补术后血清肿分型的解读[J/CD].中华疝和腹壁外科杂志(电子版),2013,7(2):107-108.
[20]Novitsky YW,Elliott HL,Orenstein SB,et al.Transversus abdominis muscle release:a novel approach to posterior component separation during complex abdominal wall reconstruction[J].Am J Surg,2012,204(5):709-16.
[21]Novitsky YW.Hernia Surgery[M].Switzerland,Springer International Publishing,2016,13:117-135.
[22]Novitsky YW,Fayezizadeh M,Majumder A,et al.Outcomes of Posterior Component Separation With Transversus Abdominis Muscle Release and Synthetic Mesh Sublay Reinforcement[J].Ann Surg,2016,264(2):226-232.
[23]Silecchia G,Campanile FC,Sanchez L,et al.Laparoscopic ventral/incisional hernia repair:updated guidelines from the EAESand EHS endorsed Consensus Development Conference[J].Surg Endosc,2015,29(9):2463-2484.
[24]中华医学会外科学分会疝和腹壁外科学组,中国医师协会外科医师分会疝和腹壁外科医师委员会.腹壁切口疝诊断和治疗指南(2018年版)[J/CD],中华疝和腹壁外科杂志(电子版),2018,12(4):241-243.
[25]王平,叶静.美国腹部疝新分级系统[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(2):81-83.
[26]Petro CC,O'Rourke CP,Posielski NM,et al.Designing a ventral hernia staging system[J].Hernia,2016,20(1):111-117.
[27]Schwarz J,Reinpold W,Bittner R.Endoscopic mini/less open sublay technique(EMILOS)-a new technique for ventral hernia repair[J].Langenbecks Arch Surg,2017,402(1):173-180.
[28]K?ckerling F,Botsinis MD,Rohde C,et al.Endoscopic-Assisted Linea Alba Reconstruction plus Mesh Augmentation for Treatment of Umbilical and/or Epigastric Hernias and Rectus Abdominis Diastasis-Early Results[J].Front Surg,2016,3:27.
[29]Chandra R,Jacobson RA,Poirier J,et al.Successful non-operative management of intraabdominal hypertension and abdominal compartment syndrome after complex ventral hernia repair:a case series[J].Am J Surg,2018 216(4):819-823.
[30]Mohan R,Hui-Chou HG,Wang HD,et al.Physiologic changes with abdominal wall reconstruction in a porcine abdominal compartment syndrome model[J].Hernia,2015 Apr;19(2):313-21.
[31]Miserez M,Penninckx F.Endoscopic totally preperitoneal ventral hernia repair[J].Surg Endosc,2002,16(8):1207-1213.
[32]Bellido J,Bellido A,Valdivia J,et al.Totally endoscopic surgery on diastasis recti associated with midline hernias.The advantages of a minimally invasive approach.Prospective cohort study[J].Hernia,2015,19(3):493-501.
[33]Capitano S.Totally extraperitoneal approach for ventral hernia[J].Surg Endosc,2018,32(3):1585-1585.
[34]Winder JS,Lyn-Sue J,Kunselman AR,et al.Differences in midline fascial forces exist following laparoscopic and open transversus abdominis release in a porcine model[J].Surg Endosc,2017,31(2):829-836.
[35]Moore AM,Anderson LN,Chen DC..Laparoscopic stapled sublay repair with self-gripping mesh:a simplified technique for minimally invasive extraperitoneal ventral hernia repair[J].Surg Technol Int,2016,29:131-139.
[36]Halka JT,Vasyluk A,DeMare AM,et al.Robotic and hybrid robotic transversus abdominis release may be performed with low length of stay and wound morbidity[J].Am J Surg,2018,215(3):462-465.
[37]Yheulon CG,Maxwell DW,Balla FM,et al..Robotic-assisted laparoscopic repair of scrotal inguinal hernias[J].Surg Laparosc Endosc Percutan Tech,2018,28(3):188-192.
[38]Abdalla R,Garcia R,da Costa R,et al.Treatment of mid-line abdominal wall hernias with the use of endo-stapler for mid-line closure[J].Arq Bras Cir Dig,2013,26(4):335-7.
[39]Costa T,Abdalla R,Santo M,et al.Transabdominal midline reconstruction by minimally invasive surgery:technique and results[J].Hernia,2016,20(2):257-265.
[40]Montgomery A.The best of two worlds:a new innovative laparoscopic Rives-Stoppa technique for ventral/incisional hernias-“the Brazilian technique”[J].Hernia,2016,20(2):267-270.
[41]Schroeder AD,Debus ES,Schroeder M,et al.Laparoscopic transperitoneal sublay mesh repair:a new technique for the cure of ventral and incisional hernias[J].Surg Endosc,2013,27(2):648-654.
[42]Li B,Qin C,Bittner R.Totally endoscopic sublay(TES)repair for midline ventral hernia:surgical technique and preliminary results[J].Surg Endosc,2018 Oct 29.
[43]Yang GPC.From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair[J].Asian J Endosc Surg.2017,10(2):119-127.
[2]Chalabi H,Larkin J,Mehigan B,et al.A systematic review of laparoscopic versus open abdominal incisional hernia repair,with meta-analysis of randomized controlled trials[J].Int J Surg,2015,20:65-74.
[3]Awaiz A,Rahman F,Hossain MB,et al.Meta-analysis and systematic review of laparoscopic versus open mesh repair for elective incisional hernia[J].Hernia,2015,19(3):449-463.
[4]Arita NA,Nguyen MT,Nguyen DH,et al.Laparoscopic repair reduces incidence of surgical site infections for all ventral hernias[J].Surg Endosc,2015,29(7):1769-1780.
[5]Sauerland S,Walgenbach M,Habermalz B,et al.Laparoscopic versus open surgical techniques for ventral or incisional hernia repair[J].Cochrane Database Syst Rev,2011,16(3):CD007781.
[6]Bittner R,Bingener-Casey J,Dietz U,et al.Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias(International Endohernia Society[IEHS])-PartⅡ[J].Surg Endosc,2014,28(2):353-379.
[7]Bittner R,Bingener-Casey J,Dietz U,et al.Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias(International Endohernia Society[IEHS])-Part III[J].Surg Endosc,2014,28(2):380-404.
[8]Liang MK,Holihan JL,Itani K,et al.Ventral hernia management:expert consensus guided by systematic review[J].Ann Surg,2017,265(1):80-89.
[9]Rives J,Pire JC,Flament JB,et al.Treatment of large eventrations(apropos of 133 cases)[J].Minerva Chir,1977,32(11):749-756.
[10]Stoppa R,Warlaumont C,Chantriaux JF.Prosthetic surgical treatment of inguinal hernias.Parietalization of the spermatic cord[J].Presse Med,1984,13(38):2317-2318.
[11]Stoppa R,Rives J,Warlaumont C,et al.The use of Dacron in the repair of hernias of the groin[J].Surg Clin North Am,1984,64(2):269-285.
[12]Conze J,Binneb?sel M,Junge K,et al.Incisional hernia-how do I do it?Standard surgical approach[J].Chirurg,2010,81(3):192-200.
[13]Muysoms FE,Miserez M,Berrevoet F,et al.Classification of primary and incisional abdominal wall hernias[J].Hernia,2009,13(4):407-414.
[14]Amid PK,Lichtenstein IL.Retromuscular alloplasty of large scar hernias:a simple staple attachment technique[J].Chirurg,1996,67(6):648-652.
[15]Reinpold W.Neue Techniken in der Narben-und Bauchwandhernienchirurgie[J].Chirurgische Allgemeine,2013,14:331-337.
[16]Schwarz J,Reinpold W,Bittner R.Endoscopic mini/less open sublay technique(EMILOS)-a new technique for ventral hernia repair[J].Langenbecks Arch Surg,2017,402(1):173-180.
[17]Reinpold W,Schr?der M,Berger C,,et al.Mini-or Less-open Sublay Operation(MILOS):A New Minimally Invasive Technique for the Extraperitoneal Mesh Repair of Incisional Hernias[J].Ann Surg,2018,16.
[18]Morales-Conde S.A new classification for seroma after laparoscopic ventral hernia repair[J].Hernia,2012,16(3):261-267.
[19]王平.腹腔镜腹部疝修补术后血清肿分型的解读[J/CD].中华疝和腹壁外科杂志(电子版),2013,7(2):107-108.
[20]Novitsky YW,Elliott HL,Orenstein SB,et al.Transversus abdominis muscle release:a novel approach to posterior component separation during complex abdominal wall reconstruction[J].Am J Surg,2012,204(5):709-16.
[21]Novitsky YW.Hernia Surgery[M].Switzerland,Springer International Publishing,2016,13:117-135.
[22]Novitsky YW,Fayezizadeh M,Majumder A,et al.Outcomes of Posterior Component Separation With Transversus Abdominis Muscle Release and Synthetic Mesh Sublay Reinforcement[J].Ann Surg,2016,264(2):226-232.
[23]Silecchia G,Campanile FC,Sanchez L,et al.Laparoscopic ventral/incisional hernia repair:updated guidelines from the EAESand EHS endorsed Consensus Development Conference[J].Surg Endosc,2015,29(9):2463-2484.
[24]中华医学会外科学分会疝和腹壁外科学组,中国医师协会外科医师分会疝和腹壁外科医师委员会.腹壁切口疝诊断和治疗指南(2018年版)[J/CD],中华疝和腹壁外科杂志(电子版),2018,12(4):241-243.
[25]王平,叶静.美国腹部疝新分级系统[J/CD].中华疝和腹壁外科杂志(电子版),2017,11(2):81-83.
[26]Petro CC,O'Rourke CP,Posielski NM,et al.Designing a ventral hernia staging system[J].Hernia,2016,20(1):111-117.
[27]Schwarz J,Reinpold W,Bittner R.Endoscopic mini/less open sublay technique(EMILOS)-a new technique for ventral hernia repair[J].Langenbecks Arch Surg,2017,402(1):173-180.
[28]K?ckerling F,Botsinis MD,Rohde C,et al.Endoscopic-Assisted Linea Alba Reconstruction plus Mesh Augmentation for Treatment of Umbilical and/or Epigastric Hernias and Rectus Abdominis Diastasis-Early Results[J].Front Surg,2016,3:27.
[29]Chandra R,Jacobson RA,Poirier J,et al.Successful non-operative management of intraabdominal hypertension and abdominal compartment syndrome after complex ventral hernia repair:a case series[J].Am J Surg,2018 216(4):819-823.
[30]Mohan R,Hui-Chou HG,Wang HD,et al.Physiologic changes with abdominal wall reconstruction in a porcine abdominal compartment syndrome model[J].Hernia,2015 Apr;19(2):313-21.
[31]Miserez M,Penninckx F.Endoscopic totally preperitoneal ventral hernia repair[J].Surg Endosc,2002,16(8):1207-1213.
[32]Bellido J,Bellido A,Valdivia J,et al.Totally endoscopic surgery on diastasis recti associated with midline hernias.The advantages of a minimally invasive approach.Prospective cohort study[J].Hernia,2015,19(3):493-501.
[33]Capitano S.Totally extraperitoneal approach for ventral hernia[J].Surg Endosc,2018,32(3):1585-1585.
[34]Winder JS,Lyn-Sue J,Kunselman AR,et al.Differences in midline fascial forces exist following laparoscopic and open transversus abdominis release in a porcine model[J].Surg Endosc,2017,31(2):829-836.
[35]Moore AM,Anderson LN,Chen DC..Laparoscopic stapled sublay repair with self-gripping mesh:a simplified technique for minimally invasive extraperitoneal ventral hernia repair[J].Surg Technol Int,2016,29:131-139.
[36]Halka JT,Vasyluk A,DeMare AM,et al.Robotic and hybrid robotic transversus abdominis release may be performed with low length of stay and wound morbidity[J].Am J Surg,2018,215(3):462-465.
[37]Yheulon CG,Maxwell DW,Balla FM,et al..Robotic-assisted laparoscopic repair of scrotal inguinal hernias[J].Surg Laparosc Endosc Percutan Tech,2018,28(3):188-192.
[38]Abdalla R,Garcia R,da Costa R,et al.Treatment of mid-line abdominal wall hernias with the use of endo-stapler for mid-line closure[J].Arq Bras Cir Dig,2013,26(4):335-7.
[39]Costa T,Abdalla R,Santo M,et al.Transabdominal midline reconstruction by minimally invasive surgery:technique and results[J].Hernia,2016,20(2):257-265.
[40]Montgomery A.The best of two worlds:a new innovative laparoscopic Rives-Stoppa technique for ventral/incisional hernias-“the Brazilian technique”[J].Hernia,2016,20(2):267-270.
[41]Schroeder AD,Debus ES,Schroeder M,et al.Laparoscopic transperitoneal sublay mesh repair:a new technique for the cure of ventral and incisional hernias[J].Surg Endosc,2013,27(2):648-654.
[42]Li B,Qin C,Bittner R.Totally endoscopic sublay(TES)repair for midline ventral hernia:surgical technique and preliminary results[J].Surg Endosc,2018 Oct 29.
[43]Yang GPC.From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair[J].Asian J Endosc Surg.2017,10(2):119-127.