Attention should be paid to the prevention and management of complications of complex abdominal hernia surgery

doi:10.3877/cma.j.issn.1674-392X.2024.06.001

Abstract

Abstract:

The condition of complex abdominal wall hernia is complicated, with many complications, and the treatment is difficult and challenging.This article provides an overview of the definition, grading and classification of complex abdominal wall hernia.The evolution of the surgical methods of abdominal wall hernia and the selection principle of the surgical methods are presented.The prevention and management of complex abdominal hernia complications from micro and macro aspects are emphasized.

Key words: Complex abdominal hernia, Complications, Surgical methods, Technical training, Quality control, Hernia registry and follow-up system

Zhenling Ji, Jie Chen, Jianxiong Tang. Attention should be paid to the prevention and management of complications of complex abdominal hernia surgery[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 601-606.

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References 30

[1]	庞国义, 韩加刚, 赵琦, 等.脱细胞异体真皮基质补片修补复杂性腹壁疝36 例经验总结[J].中国实用外科杂志, 2012, 32(2):156-157.
[2]	Slater NJ, Montgomery A, Berrevoet F, et al.Criteria for definition of a complex abdominal wall hernia[J].Hernia, 2014, 18(1): 7-17.
[3]	杨硕, 陈杰.腹腔镜手术治疗复杂腹壁疝价值探讨[J].中国实用外科杂志, 2015, 35(11): 1157-1161.
[4]	Capoccia Giovannini S, Podda M, Ribas S, et al.What defines an incisional hernia as 'complex': results from a Delphi consensus endorsed by the European Hernia Society(EHS)[J].Br J Surg, 2024,111(1): znad346.
[5]	Dindo D, Demartines N, Clavien PA.Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey[J].Ann Surg, 2004, 240: 205-213.
[6]	Slankamenac K, Graf R, Barkun J, et al.The comprehensive complication index: a novel continuous scale to measure surgical morbidity[J].Ann Surg, 2013, 258(1): 1-7.
[7]	Löffel LM, Gross T, Schneider MP, et al.Complication reporting with the Bern Comprehensive Complication Index CCI after open radical prostatectomy: A longitudinal long-term single-center study[J].Urol Oncol, 2020, 38(3): 79.e1-79.e8.
[8]	Yang W, Peng Y, Yang Y, et al.Combining occlusion of the right hepatic vein with the Pringle maneuver in laparoscopic anatomic right posterior liver resection[J].Surg Endosc, 2024, 38(12):7627-7633.
[9]	Kuriyama N, Fujii T, Kaluba B, et al.Short-term surgical outcomes of open, laparoscopic, and robot-assisted pancreatoduodenectomy: A comparative, single-center, retrospective study[J].Asian J Endosc Surg, 2025, 18(1): e13397.
[10]	Chuang SH, Kuo KK, Chuang SC, et al.Routine single-incision laparoscopic common bile duct exploration with concomitant cholecystectomy for elderly patients: a 6-year retrospective comparative study[J].Surg Endosc, 2024, 38(11): 6963-6972.
[11]	Barranquero AG, Maestre González Y, Gas Ruiz C, et al.Early outcomes of robotic modified retromuscular Sugarbaker technique for end colostomy parastomal hernia repair[J].Hernia, 2024, 28(6):2235-2243.
[12]	Tryliskyy Y, Demykhova I, Kebkalo A, et al.Minimally Invasive Extended Totally Extraperitoneal Versus Transabdominal Retromuscular Ventral Hernia Mesh Repair: Systematic Review and Meta-Analysis[J].J Laparoendosc Adv Surg Tech A, 2024, 34(1): 39-46.
[13]	Liu L, Zheng L, Zhang M, et al.Incidence and risk factors for parastomal hernia with a permanent colostomy[J].J Surg Oncol,2022, 126(3): 535-543.
[14]	顾岩, 宋致成, 杨建军.腹壁巨大缺损修补术后并发症防治[J].中国实用外科杂志, 2020, 40(7): 781-784.
[15]	Zolin SJ, Fafaj A, Krpata DM.Transversus abdominis release(TAR):what are the real indications and where is the limit?[J].Hernia, 2020,24(2): 333-340.
[16]	Chevrel JP.The treatment of large midline incisional hernias by―overcoat” plasty and prothesis(author's transl)][J].Nouv Presse Med, 1979, 8(9): 695-696.
[17]	Read RC, Barone GW, Hauer-Jensen M, et al.Properitoneal prosthetic placement through the groin.The anterior(Mahorner-Goss,Rives-Stoppa) approach[J].Surg Clin North Am, 1993, 73(3):545-555.
[18]	LeBlanc KA, Booth WV.Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings[J].Surg Laparosc Endosc, 1993, 3(1): 39-41.
[19]	Bittner R, Bain K, Bansal VK, et al.Update of Guidelines for laparoscopic treatment of ventral and incisional abdominal wall hernias(International Endohernia Society(IEHS)): Part B[J].Surg Endosc, 2019, 33(11): 3511-3549.
[20]	Claus CMP, Malcher F, Cavazzola LT, et al.Subcutaneous Onlay Laparoscopic Approach(SCOLA) for ventral hernia and rectus abdominal diastasis repair: technical description and initial results[J].Arq Bras Cir Dig, 2018, 31(4): e1399.
[21]	Yang GPC.From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair[J].Asian J Endosc Surg, 2017, 10(2): 119-127.
[22]	Li B, Qin C, Bittner R.Totally endoscopic sublay(TES) repair for midline ventral hernia: surgical technique and preliminary results[J].Surg Endosc, 2020, 34(4): 1543-1550.
[23]	Gómez-Valles P, Jeri-McFarlane S, Gomez-Menchero J, et al.Moving the concept associated to laparoscopic intracorporeal rectus aponeuroplasty(LIRA) to lateral hernia[J].Cir Esp(Engl Ed), 2022,100(12): 780-782.
[24]	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): 709-716.
[25]	李健文, 乐飞.腹腔镜腹壁切口疝修补术的现状和展望[J].中国普通外科杂志, 2021, 30(4): 375-379.
[26]	宋晓华.腹壁切口疝术后腹腔高压的预警及处理策略[J].外科理论与实践, 2010, 15(6): 593-596.
[27]	广东省医师协会疝与腹壁外科医师分会, 深圳市医师协会疝与腹壁外科医师分会, 中华消化外科菁英荟疝与腹壁外科学组.疝修补术后腹腔间隔室综合征预防与处理中国专家共识(2024 版)[J].中华消化外科杂志, 2024, 23(9): 1127-1139.
[28]	唐健雄.重视腹壁疝术后并发症预防及处理[J].中国实用外科杂志, 2020, 40(7): 758-760.
[29]	秦昌富, 陈杰, 申英末, 等.中国疝病注册登记随访系统对我国疝和腹壁外科的推动作用[J].临床外科杂志, 2019, 27(9): 734-736.
[30]	秦昌富, 李炳根, 申英末, 等.中国疝病注册登记随访系统的建立和发展[J].外科理论与实践, 2018, 23(4): 295-298.

1	大小和位置	腹壁缺损宽径≥10 cm，并伴有其他复杂因素；
		造口旁疝；
		腰疝；
		侧腹壁疝和肋缘下疝；
		腹壁失容（Loss of Domain）≥20%。
2	污染和软组织情况	外科伤口分类Ⅲ（污染）或Ⅳ（重度污染）；
		全腹壁缺损；
		组织丧失（如肿瘤切除后、创伤、感染）；
		腹壁解剖变形（接受多次修补手术）；
		肌肉去神经；
		皮肤移植；
		腹壁伤口溃疡/未愈合伤口；
		腹壁裂开；
		疾病相关缺损（脐膨出、坏死性筋膜炎）；
		肠瘘。
3	病史和危险因素	接受过补片或组织结构分离术后复发；
		影响伤口愈合的并存病/危险因素：肥胖、老龄、使
		用类固醇药物，或营养不良（白蛋白＜30 g/L）；
		存在增加腹内压因素：肥胖、慢性阻塞性肺疾病、有伤口裂开史、发生过补片感染。
4	临床状况	需行肠切除的急诊手术；腹腔内补片修补（IPOM）术后补片去除；多发性缺损；必须行组织结构分离才可以关闭肌筋膜缺损。

1	大小和位置	腹壁缺损宽径≥10 cm，并伴有其他复杂因素；
		造口旁疝；
		腰疝；
		侧腹壁疝和肋缘下疝；
		腹壁失容（Loss of Domain）≥20%。
2	污染和软组织情况	外科伤口分类Ⅲ（污染）或Ⅳ（重度污染）；
		全腹壁缺损；
		组织丧失（如肿瘤切除后、创伤、感染）；
		腹壁解剖变形（接受多次修补手术）；
		肌肉去神经；
		皮肤移植；
		腹壁伤口溃疡/未愈合伤口；
		腹壁裂开；
		疾病相关缺损（脐膨出、坏死性筋膜炎）；
		肠瘘。
3	病史和危险因素	接受过补片或组织结构分离术后复发；
		影响伤口愈合的并存病/危险因素：肥胖、老龄、使
		用类固醇药物，或营养不良（白蛋白＜30 g/L）；
		存在增加腹内压因素：肥胖、慢性阻塞性肺疾病、有伤口裂开史、发生过补片感染。
4	临床状况	需行肠切除的急诊手术；腹腔内补片修补（IPOM）术后补片去除；多发性缺损；必须行组织结构分离才可以关闭肌筋膜缺损。

1	巨大和多发腹壁疝
2	难复性或嵌顿性腹壁疝
3	复发腹壁疝
4	合并感染的腹壁疝（包括合并疝修补材料感染的腹壁疝）
5	合并肠瘘的腹壁疝
6	合并腹水的腹壁疝
7	合并器官外露的腹壁疝
8	合并严重腹腔器官粘连的腹壁疝
9	合并腹壁肿瘤的腹壁疝
10	特殊位置的腹壁疝（包括边缘腹壁疝）

1	巨大和多发腹壁疝
2	难复性或嵌顿性腹壁疝
3	复发腹壁疝
4	合并感染的腹壁疝（包括合并疝修补材料感染的腹壁疝）
5	合并肠瘘的腹壁疝
6	合并腹水的腹壁疝
7	合并器官外露的腹壁疝
8	合并严重腹腔器官粘连的腹壁疝
9	合并腹壁肿瘤的腹壁疝
10	特殊位置的腹壁疝（包括边缘腹壁疝）

1	宽度超过10 cm
2	中线切口疝伴造口旁疝
3	多发复发疝
4	腹腔失容
5	存在皮肤缺损/溃疡
6	存在瘘管
7	当前补片感染
8	当前腹壁感染
9	网片侵蚀进入肠道
10	造口的存在
11	既往腹部开放
12	既往前组织结构分离
13	既往后组织结构分离
14	既往腹直肌腹横肌皮瓣重建术
15	肌肉缺失/既往肌肉切除
16	骨切除术后切口疝
17	体重指数≥40 kg/m²
18	肝硬化腹水

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