剑脐入路内镜全腹膜外腹膜前修补术在上腹中线腹壁疝中的应用

目的内镜完全腹膜外Sublay(totally extraperitoneal Sublay，TES)修补是近年治疗腹壁疝的新进展，腹膜前层面修补有助于进一步减轻腹壁创伤。笔者描述了剑脐入路内镜下全腹膜外途径的腹膜前修补上腹中线腹壁疝的初步尝试。 方法回顾2019年10月至2020年4月采用该项手术的9例患者，记录与分析患者资料、疝与手术情况、术后情况与短期随访结果。 结果9例患者均完成修补，手术时间(128±54)min，术后恢复快，无患者因并发症再次入院。无术中、术后严重并发症发生，仅1例术后发生血清肿。短期随访期间(2～6个月)无术区感染、疼痛、穿刺孔疝与复发等。 结论腹膜前修补有助于进一步降低TES修补对腹壁的创伤；与耻骨上入路比较，剑脐入路能更方便进行中、上腹小型腹壁疝的腹膜前修补。

Endoscopic totally extraperitoneal procedure for preperitoneal repair of midline ventral hernias with xiphoid-umbilicus approach

ObjectiveEndoscopic totally extraperitoneal Sublay (TES) repair seems to be a promising procedure for treating ventral hernia, repairing at the preperitoneal layer may further reduce the damage to the abdominal wall. This article reports the preliminary surgical results after such procedure with xiphoid-umbilicus approach for midline upper abdomen ventral hernia. MethodsNine cases performed with endoscopic totally extraperitoneal procedure for preperitoneal repair of midline ventral hernias with xiphoid-umbilicus approach were included, patient demographics, hernia characteristics, operative variables and surgical results were recorded and analyzed. ResultsAll repairs were completed successfully, the operation during was (128±54)min. All patients recovered quickly and uneventfully and no case needed readmission. No severe intraoperative and postoperative complications occurred, only one case developed seroma. No surgical site infection, pain, trocar site hernia and recurrence were observed during short-term follow-up (2 to 6 months). ConclusionsEndoscopic preperitoneal repair may help to reduce the damage to the abdominal wall during TES procedure. Comparing with suprapubic approach, xiphoid-umbilicus approach facilitates the preperitoneal repair for small ventral hernia of upper abdomen.