Laparoscopic slit mesh repair of parastomal hernia using a designated mesh: long-term results
Laparoscopic slit mesh repair of parastomal hernia using a designated mesh: long-term results
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DOI：
10.1007/s00464-011-1866-z
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发表时间：
2012-01-01
影响因子：
3.1
通讯作者：
Parker, M. C.
中科院分区：
文献类型：
--
作者：
Mizrahi, H.;Bhattacharya, P.;Parker, M. C.
吻合口旁疝气是结直肠手术中常见的并发症，占所有吻合口形成的55%。目前，它的修复还没有明确的战略。本研究旨在评估使用缝隙网孔技术进行腹腔镜肺高压修补术的患者的预后。我们对2005-2010年间所有使用设计的缝隙网眼/锁孔技术进行腹腔镜肺高压修补术的患者进行了回顾性病例回顾。吻合口对面放置三个孔口，仔细做粘连松解和腹股沟内容物减少术。测量吻合口旁筋膜缺损处，并用指定的网眼覆盖。网片的固定采用同心钉和经皮普鲁林缝合。29例行腹腔镜下腹股沟疝修补术，平均年龄63.5岁(42~81岁，中位年龄)，其中18例(62.1%)行吻合口旁疝修补术，10例(34.5%)行回肠造瘘口旁腹股沟疝修补术，1例(3.4%)行回肠导管疝修补术。平均手术时间179分钟(范围80~300分钟，中位时间180分钟)。2例(6.9%)中转开放手术。术后早期并发症4例(13.8%)，包括1例老年严重合并症患者死于术后脓毒症(死亡率3.4%)。仅有1例晚期并发症发生(3.4%)。平均住院时间4.7天(范围1-19天；中位数3天)。平均随访时间28个月(范围12-53个月；中位数30个月)。28例患者中有13例复发(46.4%)，腹腔镜下裂隙网片/锁孔修补术是可行的，但手术时间延长是一项复杂的手术。复发率高，提示对该方法的技术改进是必要的。
Parastomal hernia (PH) is a frequent complication of colorectal surgery, which incidence reaches 55% of all stoma formation. Currently, there is no definitive strategy for its repair. This study was designed to assess the outcome in patients who underwent laparoscopic PH repair using a slit mesh/keyhole technique.We undertook a retrospective case review of all patients who underwent laparoscopic PH repair with a designed slit mesh/keyhole between 2005 and 2010. Three ports were placed opposite the stoma site, and careful adhesiolysis and hernia content reduction were performed. The parastomal fascial defect was measured and covered with a designated mesh. Fixation of the mesh was achieved with concentric tacks and transcutaneous Prolene suture. Recurrence was diagnosed after examination of patients by two surgeons or by imaging demonstrating an indolent hernia.Twenty-nine laparoscopic PH mesh repairs were performed with an average age of 63.5 (range 42-81, median 64) years to treat paracolostomy hernia in 18 of 29 cases (62.1%), para-ileostomy hernia in 10 of 29 cases (34.5%), and for an ileal conduit site hernia in 1 of 29 cases (3.4%). The average operative time was 179 (range, 80-300; median, 180) min. Two operations (6.9%) were converted to an open approach. Early postoperative complications were documented in four patients (13.8%), including one elderly patient with severe comorbidities who died from postoperative sepsis (mortality rate, 3.4%). Only one late complication was recorded (3.4%). The average hospital stay was 4.7 (range, 1-19; median, 3) days. Average follow-up time was 28 (range, 12-53; median, 30) months. Recurrence of the hernia was found in 13 of 28 patients (46.4%).Laparoscopic slit mesh/keyhole repair is feasible, although it is a complex surgery reflected by extended operative time. The high recurrence rate suggests that technical improvement of the method is essential.