Laparoscopic treatment of ventral abdominal wall hernias: preliminary results in 100 patients.

OBJECTIVE: The laparoscopic treatment of eventrations and ventral hernias has been little used, although these hernias are well suited to a laparoscopic approach. The objective of this study was to investigate the usefulness of a laparoscopic approach in the surgical treatment of ventral hernias. METHODS: Between January 1994 and July 1998, a series of 100 patients suffering from major abdominal wall defects were operated on by means of laparoscopic techniques, with a mean postoperative follow-up of 30 months. The mean number of defects was 2.7 per patient, the wall defect was 93 cm2 on average. There were 10 minor hernias (<5 cm), 52 medium-size hernias (5-10 cm), and 38 large hernia (>10 cm). The origin of the wall defect was primary in 21 cases and postsurgical in 79. Three access ports were used, and the defects were covered with PTFE Dual Mesh measuring 19 x 15 cm in 54 cases, 10 x 15 cm in 36 cases, and 12 x 8 cm in 10 cases. An additional mesh had to be added in 21 cases. In the last 30 cases, PTFE Dual Mesh Plus with holes was employed. RESULTS: Average surgery time was 62 minutes. One procedure was converted to open surgery, and only one patient required a second operation in the early postoperative period. Minor complications included 2 patients with abdominal wall edema, 10 seromas, and 3 subcutaneous hematomas. There were no trocar site infections. Two patients developed hernia relapse (2%) in the first month after surgery and were reoperated with a similar laparoscopic technique. Oral intake and mobilization began a few hours after surgery. The mean stay in hospital was 28 hours. CONCLUSIONS: Laparoscopic technique makes it possible to avoid large incisions, the placement of drains, and produces a lower number of seromas, infections and relapses. Laparoscopic access considerably shortens the time spent in the hospital.     

生物补片一期修复污染状态下的腹壁疝和腹壁缺损

目的：评价生物补片用于污染或感染状态下腹壁缺损一期修复的安全性和有效性。方法 2010年4月以来17例腹壁缺损手术均因肠外瘘或肠造口、切口感染或同时肠道手术等原因而处于感染或污染状态：切口疝6例,腹股沟嵌顿疝1例,肠外瘘8例、直肠癌柱状切除术2例。腹壁缺损范围在(3 cm ×2 cm)～(6 cm×17 cm),均采用...     

Classification of primary and incisional abdominal wall hernias

Purpose  A classification for primary and incisional abdominal wall hernias is needed to allow comparison of publications and future studies on these hernias. It is important to know whether the populations described in different studies are comparable. Methods  Several members of the EHS board and some invitees gathered for 2 days to discuss the development of an EHS classification for primary and incisional abdominal wall hernias. Results  To distinguish primary and incisional abdominal wall hernias, a separate classification based on localisation and size as the major risk factors was proposed. Further data are needed to define the optimal size variable for classification of incisional hernias in order to distinguish subgroups with differences in outcome. Conclusions  A classification for primary abdominal wall hernias and a division into subgroups for incisional abdominal wall hernias, concerning the localisation of the hernia, was formulated.

腹腔镜技术在腹部外科中的应用(附19例报告)

目的:总结分析腹腔镜技术在腹部外科疾病中的诊断和治疗效果。方法:回顾分析2003年8月至2005年8月应用腹腔镜技术对19例腹部外科疾病患者行诊断和治疗的临床资料。结果:6例腹部外伤患者行腹腔镜下止血治疗后痊愈出院,6例慢性阑尾炎行腹腔镜阑尾切除术(LA)治愈出院,2例肝纤维样肿块随访,肝右前叶下段肝细胞肝癌、肝右前叶下段表面囊肿、小肠外生性息肉样病变各1例,均获得满意治疗,随访无并发症发生。结论:腹腔镜技术在腹部外科疾病的诊断和治疗方面占有很大的优势,应用前景广阔。     

Laparoscopic repair of traumatic abdominal wall hernia from handlebar injury

A 14-year-old boy was seen at an outside hospital after falling over the handlebar of his bicycle and was discharged home. He was subsequently seen in our emergency department with complaints of persistent abdominal pain. A computed tomography scan of the abdomen revealed disruption of the muscles of the upper right abdominal wall containing the hepatic flexure of the colon, with a small amount of intraperitoneal free fluid noted. The patient underwent laparoscopic exploration using 3 ports (2-5 mm and 1-12 mm) and 2 separate stab incisions. The traumatic abdominal wall hernia was repaired with interrupted sutures placed with an ENDO CLOSE (Covidien, Mansfield, MA) device, and a mesenteric defect in the colon was approximated with intracorporeal sutures. The trocar sites were sutured closed. The patient recovered well and was discharged home. Follow-up examination revealed no abdominal wall defect and resolution of his symptoms.Laparoscopic repair of a traumatic abdominal wall defect and exploratory laparoscopy after trauma is feasible and safe in the pediatric patient. It should be considered as an alternative approach with potentially less morbidity than an exploratory laparotomy for handlebar injuries in a stable patient.     

Open vs laparoscopic repair of secondary lumbar hernias: a prospective nonrandomized study

Background Lumbar hernias are uncommon defects of the posterior abdominal wall. Surgical treatment is still controversial in these cases. The aim of this study was to compare outcome and costs of the laparoscopic approach vs the open method.Methods We conducted a prospective nonrandomized study of 16 patients who underwent operation for secondary lumbar hernia between January 1997 and January 2003. Hine were treated via the laparoscopic approach and seven with an open technique. The following variables were analyzed: clinical data, hospital data (operating time and length of stay), patient comfort (consumption of analgesics and time to return to normal activities), and recurrences. Hospital costs were also analyzed.Results There were no differences between the two groups in terms of age and history, although the defects of the patients in the laparoscopic group were smaller. Mean operating time, postoperative morbidity, mean hospital stay, consumption of analgesics, and time to return to normal activities were significantly lower in the laparoscopic group (p < 0. 01). No were there any statistical differences between the two types of surgical procedure in terms of hospital costs. However, the final cost did show differences when expenses for readmissions and recurrences were taken into account (p < 0.01).Conclusion The laparoscopic approach to secondary lumbar hernia repair is more efficient and more profitable than the traditional open technique.     

Telerobotic laparoscopic repair of incisional ventral hernias using intraperitoneal prosthetic mesh.

Laparoscopic ventral hernia repair shortens the length of hospital stay and achieves low rates of hernia recurrence. The inherent difficulties of performing advanced laparoscopy operations, however, have limited the adoption of this technique by many surgeons. We hypothesized that the virtual operative field and hand-like instruments of a telerobotic surgical system could overcome these limitations. We present herein the first 2 reported cases of telerobotic laparoscopic ventral hernia repair with mesh. The operations were accomplished with the da Vinci telerobotic surgical system. The hernia defects were repaired with dual-sided, expanded polytetrafluoroethylene (ePTFE) mesh. The mesh was secured in place with 8 sutures that were passed through the abdominal wall, and 5-mm surgical tacks were placed around the circumference of the mesh. The 2 operations were accomplished with total operative times of 120 and 135 minutes and total operating room times of 166 and 180 minutes, respectively. The patients were discharged home on postoperative days 1 and 4. The surgeon sat in an ergonomically comfortable position at a computer console that was remote from the patient. Immersion of the surgeon within the 3-dimensional virtual operative field expedited each stage of these procedures. The articulation of the wristed telerobotic instruments greatly facilitated reaching the anterior abdominal cavity near the abdominal wall. This report indicates that telerobotic laparoscopic ventral hernia repair is feasible and suggests that telepresence technology facilitates this procedure.     

Surgical technique and complications during laparoscopic repair of diaphragmatic hernias

Diaphragmatic hernias can present as retrocostoxiphoid hernias (RCXH) or diaphragmatic dome hernias. The RCXH include the Larrey hernia (LH), the Morgagni hernia (MH), and the Larrey–Morgagni hernia (LMH). These congenital hernias are usually asymptomatic, and the diagnosis is simplified by two exams: chest X-ray, and thoraco-abdominal computed tomography (CT) scan. The potential risk in this condition is small-bowel incarceration in the hernia defect and subsequent obstruction. We report two cases of LH and one case of LMH treated by laparoscopy between February 2004 and October 2005, with a review of the surgical techniques. Two different laparoscopic techniques were used: the tension-free technique, and resection of the hernia sac with closure of the defect and reinforcement by prosthesis. One patient presented a postoperative cardiac tamponade due to a clip-induced bleeding of an epicardial artery at the inferior surface of the heart. Treatment by laparoscopy is feasible, but a consensus regarding the best laparoscopic repair is needed.     

腹腔镜联合手术治疗胆囊结石及腹腔脏器伴发疾病的临床体会

目的：总结腹腔镜联合手术治疗胆囊结石及腹腔脏器伴发疾病的临床经验.方法：回顾分析我院腹腔镜诊疗中心1996年6月至2006年6月为1 515例胆囊结石伴其他腹腔脏器疾病患者实施腹腔镜下联合手术的临床资料.结果：1 515例中转开腹4例,其余均联合手术成功,无医源性损伤和手术死亡病例.结论：严格遵循外科手术的基本原则,选择合适病例实施腹腔镜联合手术是安全可行的.     

腹腔镜下腹壁切口疝修补术的治疗体会(附12例报告)

目的:探讨腹腔镜下腹壁切口疝修补术的手术方法、可行性及安全性。方法:回顾分析腹腔镜下腹壁切口疝修补术12例的临床资料,包括患者年龄、性别,腹壁缺损的位置、大小,疝的内容物,修补网片的大小,手术时间,住院时间,术后并发症等。结果:手术时间50~125m in,平均80m in。术后住院时间为2~15d,平均3.5d。术后并发症发生率为8.3%,1例术后出现顽固性疼痛。平均随访32个月,术后未见复发。结论:腹腔镜下腹壁切口疝修补方法安全可行。     

腹腔镜下腹壁切口疝补片修补术的初步经验

目的:探讨腹腔镜下腹壁切口疝修补术的手术方法、安全性等问题。方法:对我院2004年3月～11月间收治的25例腹壁切口疝病人,进行腹腔镜下修补术。结果:24例(96%)手术成功,1例(4%)因腹腔内广泛粘连而中转为剖腹修补。平均手术时间为110min,平均术后住院6d,6例(24%)病人术中发现有一个以上的隐匿性缺损。术后并发症有:术后短期内修补区腹壁明显疼痛21例(84%),腹壁缝合点较长时间疼痛6例(24%),浆液肿3例(12%);无修补区感染,也未发现早期复发的病例。结论:对腹壁切口疝,多数病人是可以经腹腔镜进行粘连松解及补片修补术的,还可在术中发现其他隐性缺损。对腹腔内广泛粘连而影响操作器械的进入及分离者,应及时中转剖腹手术。     

Classification of incisional hernias of the abdominal wall

Summary Incisional hernias of the abdominal wall assume many clinical forms in terms of their site and size, the quality of the tissues of the abdominal wall and the number of previous recurrences, among many other factors. Any serious prospective and possibly comparative scientific study dealing with the results of treatment must begin by defining the type of incisional hernia studied. Hence, it seemed necessary to employ a classification allowing a study or comparison of homogeneous groups. The aim of this work was to propose a simple classification of predictive value, based on a statistical study of the relations between four parameters, i.e. the site of the incisional hernia, the width of the hernial orifice, the number of previous recurrences, and the results of treatment. A retrospective study dealing with a series of 435 abdominal incisional hernias was done to this end.This work was presented at the XXI EHS International Congress, Madrid, Spain, 3–6 November 1999     

Respiratory mechanics in abdominal compartment syndrome and large incisional hernias of the abdominal wall

Summary The abdominal compartment syndrome (ACS) is a clinical condition characterized by an increase of abdominal pressure which needs prompt abdominal decompression. The surgery of large abdominal hernias can present similar problems with an increased abdominal pressure at peritoneal closure which needs a prosthetic tension-free abdominal closure to correct the increased respiratory work-load. We undertook a study in order to compare the respiratory mechanical work-load changes during the surgery of large abdominal incisional hernias and the ACS. We measured the static compliance of the entire respiratory system (Crs), and its components-lung (CL) and chest-wall (Ccw)-during the acute phase of increased abdominal pressure and after decompressive treatment. In ACS the baseline measurements of Crs, CL, Ccw were 0.034, 0.049 and 0.115 L/cmH₂0 respectively; after decompression treatment we observed a great increase of Ccw (0.167 L/cmH₂O) whereas Cl remained the same (0.O49L/cmH₂O); Crs varied from 0.034 to 0.038 L/cmH₂O. In the surgery of large laparoceles, the Crs changed from 0.048 to 0.046 and the Ccw from 0.150 to 0.180, with an unchanged Cl. We conclude that the abdominal compartment syndrome is characterized by a well-defined alteration of respiratory work-load (decrease of chest-wall compliance), and that from a mechanical point of view there is only a quantitative difference if compared to large ventral hernia repair. The decrease of chest-wall compliance in the latter is less severe and statistically different (p = 0.002).This work was presented as a poster at the AHS EHS Joint Meeting Hernia in the 21st Century, Toronto, Canada, 15 18 June 2000     

杂交手术与腹腔镜下修补术治疗腹壁切口疝的临床研究

目的探讨杂交手术与腹腔镜下修补术治疗腹壁切口疝的临床体会。 方法回顾性分析2015年3月至2018年1月,苏州工业园区星湖医院普外科接受治疗的30例腹壁切口疝患者的临床资料。其中试验组患者14例,行杂交手术治疗;对照组患者16例,行腹腔镜下修补术。比较2组手术指标及术后疼痛情况。 结果试验组手术时间（175.63±21.15）min,与对照组（246.35±52.16）比较,差异有统计学意义（P<0.05）;试验组VAS评分、自主下床活动时间、术中出血量、住院时间、并发症发生情分别为（3.15±0.63）分、（2.49±0.35）d、（65.96±12.35）ml、（8.16±2.34）d及0,与对照组（3.65±0.52）分、（2.50±0.38）d、（66.34±13.52）ml、（8.26±2.18）d及2（12.5%）比较,差异均无统计学意义（P均>0.05）。 结论杂交手术治疗腹壁切口疝可明显缩短手术时间,且安全性好,具有较高的临床推广价值。     

开放手术辅助腹腔镜与完全腹腔镜下修补术治疗腹壁切口疝的临床研究

目的探讨分析开放手术辅助腹腔镜与完全腹腔镜下修补术治疗腹壁切口疝的临床疗效和应用。 方法回顾性分析2016年1月至2018年6月在首都医科大学附属北京潞河医院普外科就诊并进行手术治疗的41例腹壁切口疝患者的临床资料。按照随机数字法表随机分为观察组和对照组。其中观察组20例,行开放手术辅助腹腔镜疝修补术;对照组21例,行完全腹腔镜下疝修补术。比较2组患者手术情况以及术后恢复、随访并发症情况。应用SPSS 21.0统计学软件进行数据处理。 结果观察组患者手术时间（106.81±33.90）min,术中出血量（14.05±7.85）ml,并发症发生1例（5%）;对照组分别为（126.75±23.36）min,（27.25±15）ml,3例（14.29%）,差异有统计学意义（P均<0.05）。观察组术后排气时间（2.05±0.51）d、住院天数（6.95±2.31）d,对照组分别为（1.71±0.64）d、（6.38±1.24）d,差异均无统计学意义（P均>0.05）。 结论开放手术辅助腹腔镜修补术治疗腹壁切口疝可明显缩短手术时间,减少术中出血,减少术后并发症的发生,效果显著,是一种安全有效的治疗方法。     

腹腔镜下腹腔内网片植入法和开放式肌后筋膜前补片修补法治疗腹壁切口疝的疗效比较

【摘要】 目的〓比较腹腔镜下腹腔内网片植入法(IPOM)和开放式肌后筋膜前补片修补法(Sublay)治疗腹壁切口疝的疗效。方法〓回顾性分析30例腹腔镜应用IPOM法和28例开放式应用Sublay法治疗腹壁切口疝的病例,比较其手术疗效及术后患者生活质量。结果〓两组手术时间、平均住院时间、术中出血量及术后并发症比较,腹腔镜组均明显优于开放手术组,有统计学差异(P<0.05)。结论〓应用腹腔镜行IPOM治疗腹壁巨大切口疝安全可行,具有有创伤小,住院时间短,恢复快,术后并发症少的优点。     

CT检查在腹壁疝诊断中的应用

目的：研究CT检查在腹壁疝诊断中的临床价值。方法：回顾性分析2001年4月～2005年4月的4年间收治入院的101例腹壁疝病人的术前临床诊断、CT诊断和术后临床诊断。结果：术前临床诊断和CT诊断的符合率为90．2％，CT诊断和术后临床诊断的符合率为100％，术前临床诊断与术后临床诊断的符合率为90．2％。结论：CT检查在腹壁疝的临床诊断中有极其重要的指导意义。     

Laparoscopic treatment vs open surgery in the solution of major incisional and abdominal wall hernias with mesh

Background: Despite being one of the most exact indications, laparoscopic treatment of eventrations and ventral hernias is barely known among the array of laparoscopic techniques. Methods: A total of 60 patients were assigned at random over a 3-year period to two homogeneous groups to be operated on for major ventral hernias with mesh. Half of them were operated upon laparoscopically and the rest with open surgery. Early and longer-term complications were analyzed, as were operative time and postoperative hospital stays. Results: The two groups were homogeneous in terms of demographic and clinical characteristics. The group that was operated on laparoscopically presented a lower rate of postoperative and longer-term complications; similarly, surgery time was significantly lower (p < 0.05). Hospitalization time was also significantly lower than in the group undergoing conventional open surgery (p < 0.05). Conclusions: Laparoscopic treatment of postoperative eventration and primary ventral hernia reduces complications and relapse rates, eliminates reintervention through mesh infection, reduces operative time, and considerably shortens the hospital stay. Received: 22 December 1997/Accepted: 18 August 1998     

A novel laparoscopic technique for the repair of pediatric umbilical and epigastric hernias

Background/Purpose

The aim of this study was to determine whether a novel laparoscopic technique for pediatric umibilical and epigastric hernia repair is safe, quick, effective, durable, and cosmetically acceptable.

Methods

Forty-one consecutive umbilical and 13 epigastric hernias were repaired laparoscopically. Six patients had concomitant epigastric and umbilical hernias repaired during one procedure. Two 3-mm ports were used via a lateral approach. Mean age was 4.2 years for those with an umbilical hernia and 2.0 years for those with an epigastric hernia.

Results

All procedures were completed laparoscopically. The mean operative time was 27 minutes for umbilical hernia repair and 16 minutes for epigastric hernia repair. There were no intraoperative or postoperative complications. Follow-up was 100% and ranged from 6 to 35 months. There have been no recurrent hernias, and patient/parent satisfaction was subjectively excellent.

Conclusion

This case series demonstrated that this novel technique of laparoscopic anterior abdominal wall hernia repair is safe, quick, effective, durable, and cosmetically acceptable. It requires few instruments and minimal advanced laparoscopic techniques.     

The split abdominal wall muscle flap repair for large congenital diaphragmatic hernias on extracorporeal membrane oxygenation

Background

Numerous techniques exist for repairing large congenital diaphragmatic hernias (CDHs) including prosthetic patches, tissue-engineered grafts, and various muscle flaps. A split abdominal wall muscle flap is a simple, durable way to repair a large diaphragmatic hernia. This technique has not gained widespread use, and some have suggested that it would be inappropriate in the setting of extracorporeal membrane oxygenation (ECMO) because of bleeding risk. We present our series of diaphragmatic hernias with a focus on those repaired with the split abdominal wall technique while on ECMO.

Methods

A retrospective, single-institution chart review was performed on all patients who underwent surgical repair for CDH over 6 years beginning in August 2000.

Results

Seventy-five patients underwent repair. Sixteen were performed with patients on ECMO. Of these, 4 were closed primarily, 7 used a prosthetic patch, and 5 used a split abdominal wall muscle flap. Two patients in the prosthetic group developed a recurrent hernia, and 2 required reoperation for bleeding while on ECMO. No reoperations for bleeding were required in the abdominal muscle flap group.

Conclusions

The split abdominal wall muscle flap can be safely performed on anticoagulated patients. We believe it is a practical option for repairing large CDHs.