Endoscopic totally extraperitoneal sublay repair for the treatment of ventral hernia

doi:10.3877/cma.j.issn.1674-392X.2021.01.004

Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition) ›› 2021, Vol. 15 ›› Issue (01): 12-18. doi: 10.3877/cma.j.issn.1674-392X.2021.01.004

Special Issue: ；

• Clinical Article • Previous Articles Next Articles

Endoscopic totally extraperitoneal sublay repair for the treatment of ventral hernia

Weidong Wu¹, Huiyong Jiang², Xiangzhen Meng³, Guozhong Liu⁴, Xiaoyan Cai⁵, Tao Wang⁶, Jianwen Liu⁷, Xijun Cui⁸, Xianke Si⁹, Yun Wei¹, Rui Tang¹⁰^,^†()

^1. General Surgery Center, Shanghai Jiaotong University First People’s Hospital, Shanghai 200080, China
^2. Second Department of General Surgery, Zhongyi Northeast International Hospital (co-first author), Shenyang 110015, China
^3. Department of Colorectal and Hernia Minimally Invasive Surgery, Shengjing Hospital Affiliated to China Medical University, Shenyang 110004, China
^4. Department of Hepatobiliary-Pancreatic and Hernia Surgery, First Affiliated Hospital of Fujian Medical University, Fuzhou 350005, China
^5. Department of General Surgery, Hernia and Abdominal Surgery Center, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China
^6. Department of General Surgery, Zibo Central Hospital, Zibo 255036, China
^7. Department of Gastrointestinal Surgery, Shenzhen Hospital, University of Hong Kong, Shenzhen 518000, China
^8. Department of Hepatobiliary Surgery, Hernia and Abdominal Surgery, Weihai Central Hospital, Weihai 264400, China
^9. Department of Minimally Invasive Surgery, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200062, China
^10. Department of Hernia and Abdominal Surgery, Tongji University Dongfang Hospital, Shanghai 200120, China

Received:2020-05-09 Online:2021-02-18 Published:2021-04-26
Contact: Rui Tang

Abstract

Abstract:

Objective

This retrospective study was undertaken to evaluate the preliminary results of totally extraperitoneal sublay (TES) repair and summarize our experience.

Methods

115 patients with primary ventral hernia or incisional hernia underwent TES in 10 Chinese hospitals between March 2016 and July 2019 were included in this study. Patient demographics, hernia characteristics, operative variables, and surgical results were recorded and analyzed.

Results

Among 115 cases planned with TES, 114 were operated on successfully, and 1 patient was converted to IPOM repair due to severe peritoneal damage. Defect closure was achieved in 108 cases (94.74%), and permanent mesh fixation was performed in 15 cases (13.16%). Drainage was placed in 76 cases (66.67%), and the median operation time was 144 min. No severe intraoperative complications occurred. Seroma was observed in 5 cases (4.38%). After a follow-up during of 3-45 months, the overall complication rate was 17.54%. The vast majority of patients had only mild pain after surgery, without chronic pain.

Conclusion

TES is feasible, safe, and effective for the treatment of ventral hernia when surgeons have in-depth anatomic knowledge of the abdominal wall and relevant surgical skills, such as technique of "partition-breaking" and eTAR.

Key words: Hernia, ventral, Endoscopic sublay repair, Totally extraperitoneal sublay, Endoscopic transversus abdominis release

Weidong Wu, Huiyong Jiang, Xiangzhen Meng, Guozhong Liu, Xiaoyan Cai, Tao Wang, Jianwen Liu, Xijun Cui, Xianke Si, Yun Wei, Rui Tang. Endoscopic totally extraperitoneal sublay repair for the treatment of ventral hernia[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2021, 15(01): 12-18.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhshfbwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-392X.2021.01.004

https://zhshfbwkzz.cma-cmc.com.cn/EN/Y2021/V15/I01/12

Figures/Tables 5

References 28

[1]	王明刚，李航宇，李健文. "大中华腔镜疝外科学院年度工作会议"纪要[J]. 中国实用外科杂志, 2018, 38(8): 962-964.
[2]	中华医学会外科学分会腹腔镜与内镜外科学组，中华医学会外科学分会疝和腹壁外科学组，大中华腔镜疝外科学院. 切口疝腹腔镜手术规范化操作专家共识[J]. 中国实用外科杂志, 2015, 35(11): 1192-1197.
[3]	汤睿，吴卫东. 切口疝的腹腔镜Sublay修补术[J]. 腹腔镜外科杂志, 2018, 23(10): 721-724.
[4]	蒋会勇，吴卫东，马锐, 等. 腹腔镜完全腹膜外补片修补切口疝3例[J]. 临床军医杂志, 2018(2): 239-240.
[5]	蒋会勇，郭一君，张丹, 等. 腹腔镜完全腹膜外腹直肌后间隙成人脐疝修补术[J/OL]. 中华疝和腹壁外科杂志(电子版), 2018, 12(1): 47-50.
[6]	汤睿，吴卫东，周太成. 腹壁切口疝的腹腔镜sublay修补术[M]//腹外疝手术学. 北京: 科学出版社, 2019: 179-195.
[7]	Muysoms FE, Miserez M, Berrevoet F, et al. Classification of primary and incisional abdominal wall hernias [J]. Hernia, 2009, 13(4): 407-414.
[8]	Le Blanc KA, Booth WV. Laparoscopic repair of incisional abdominal hernias using expanded polytetrafluoroethylene: preliminary findings[J]. Surg Laparosc Endosc, 1993, 3: 39-41.
[9]	Heniford BT, Park A, Ramshaw BJ, et al. Laparoscopic repair of ventral hernias: nine years’ experience with 850 consecutive hernias[J]. Ann Surg, 2003, 238(3): 391-399; discussion 399-400.
[10]	Tung KLM, Cheung HYS, Tang CN. Non-healing enterocutaneous fistula caused by mesh migration [J]. ANZ, 2018, 88(1/2): E73-E74.
[11]	Holihan JL, Nguyen DH, Nguyen MT, et al. Mesh location in open ventral hernia repair: a systematic review and network meta-analysis[J]. World J Surg, 2016, 40(1): 89-99.
[12]	Kockerling F, Simon T, Adolf D, et al. Laparoscopic IPOM versus open sublay technique for elective incisional hernia repair: a registry-based, propensity score-matched comparison of 9907 patients[J]. Surgl Endosc, 2019, 33(10): 3361-3369.
[13]	Ahmed MA, Tawfic QA, Schlachta CM, et al. Pain and surgical outcomes reporting after laparoscopic ventral hernia repair in relation to mesh fixation technique: a systematic review and meta-analysis of randomized clinical trials[J]. J Laparoendosc Adv Surg Tech A, 2018, 28(11): 1298-1315.
[14]	Miserez M, Penninckx F. Endoscopic totally preperitoneal ventral hernia repair[J]. Surg Endosc, 2002, 16(8): 1207-1213.
[15]	Reinpold W, Schröder 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, 1: 1-8.
[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: 173-180.
[17]	Belyansky I, Daes J, Radu VG, et al. A novel approach using the enhanced-view totally extraperitoneal(eTEP) technique for laparoscopic retromuscular hernia repair[J]. Surg Endosc, 2018, 32(3): 1525-1532.
[18]	Belyansky I, Zahiri HR, Park A. Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction[J]. Surg Innov, 2015, 23(2): 403-406.
[19]	Bellido Luque JA, Bellido Luque A, Gomez Menchero J, et al. Safety and effectiveness of self-adhesive mesh in laparoscopic ventral hernia repair using transabdominal preperitoneal route[J]. Surg Endosc, 2017, 31(3): 1213-1218.
[20]	Yang GPC. From intraperitoneal onlay mesh repair to preperitoneal onlay mesh repair[J]. Asian J Endosc Surg, 2017, 10(2): 119-127.
[21]	Prasad P. Laparoscopic ventral hernia repair: a comparative study of transabdominal preperitoneal versus intraperitoneal onlay mesh repair[J]. J Laparoendosc Adv Surg Tech A, 2011, 21(6): 477-483.
[22]	Sugiyama G, Chivukula S, Chung PJ, et al. Robot-assisted transabdominal preperitoneal ventral hernia repair[J]. JSLS, 2015, 19(4): e2015.
[23]	Orthopoulos G, Kudsi O Y. Feasibility of robotic-assisted transabdominal preperitoneal ventral hernia repair[J]. J Laparoendosc Adv Surg Tech A, 2018, 28(4): 434-438.
[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]	Novitsky YW. Posterior component separation via transversus abdominis muscle release: the TAR procedure[M]//Novitsky YW. Hernia Surgery. Springer International Publishing, 2016: 117-135.
[26]	Belyansky I, Zahiri HR, Park A. Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction [J]. Surg Innov, 2016, 23(2): 134-141.
[27]	Fiori F, Ferrarra F, Gentile D, et al. Totally endoscopic sublay anterior repair for ventral and incisional hernias[J]. J Laparoendosc Adv Surg Tech A, 2019.
[28]	Penchev D, Kotashev G, Mutafchiyski V. Endoscopic enhanced-view totally extraperitoneal retromuscular approach for ventral hernia repair[J]. Surg Endosc, 2019, 33(11): 3749-3756.

手术及术后情况		数据
疝囊处理[例(%)]
	回纳	63(55.26)
	横断	51(44.74)
缺损关闭[例(%)]
	否	6(5.26)
	是	108(94.74)
	缝合关闭	61(53.51)
	钩线针关闭	47(41.23)
补片固定[例(%)]
	无	51(44.74)
	临时固定	48(42.11)
	医用胶	27(23.68)
	自粘补片	21(18.42)
	永久固定	15(13.16)
	钉枪	12(10.53)
	穿筋膜	3(2.63)
手术时间(min)		144(120~183)
引流放置		76(66.67%)
引流拔除时间(d)¹		3(3~4)
饮食恢复时间(d) VAS 48 h²		2(1~3)
轻度		101(88.60)
	1	34(29.82)
	2	36(31.58)
	3	31(27.19)
中度		13(11.40)
	4	6(5.26)
	5	5(4.39)
	6	2(1.75)
重度(7~10)		0
术后住院时间(d)		4(3~6)

手术及术后情况		数据
疝囊处理[例(%)]
	回纳	63(55.26)
	横断	51(44.74)
缺损关闭[例(%)]
	否	6(5.26)
	是	108(94.74)
	缝合关闭	61(53.51)
	钩线针关闭	47(41.23)
补片固定[例(%)]
	无	51(44.74)
	临时固定	48(42.11)
	医用胶	27(23.68)
	自粘补片	21(18.42)
	永久固定	15(13.16)
	钉枪	12(10.53)
	穿筋膜	3(2.63)
手术时间(min)		144(120~183)
引流放置		76(66.67%)
引流拔除时间(d)¹		3(3~4)
饮食恢复时间(d) VAS 48 h²		2(1~3)
轻度		101(88.60)
	1	34(29.82)
	2	36(31.58)
	3	31(27.19)
中度		13(11.40)
	4	6(5.26)
	5	5(4.39)
	6	2(1.75)
重度(7~10)		0
术后住院时间(d)		4(3~6)

并发症	[例(%)]
术中
大血管损伤	0
脏器损伤	1(0.88)
术后短期(术后1个月以内)
伤口感染或愈合延迟	3(2.63)
血清肿	2(1.75)
血肿	2(1.75)
出血	2(1.75)
腹壁水肿	2(1.75)
肠梗阻	1(0.88)
尿道感染	2(1.75)
肺部感染	1(0.88)
心血管意外	0
深静脉血栓	0
术后长期(术后1个月以后)
血清肿¹	3(2.63)
复发	0
穿刺孔疝	0
伤口延迟感染	1(0.88)
补片感染	0
肠梗阻	0
延迟性肠瘘	0
慢性疼痛	0
合计	20(17.54)

并发症	[例(%)]
术中
大血管损伤	0
脏器损伤	1(0.88)
术后短期(术后1个月以内)
伤口感染或愈合延迟	3(2.63)
血清肿	2(1.75)
血肿	2(1.75)
出血	2(1.75)
腹壁水肿	2(1.75)
肠梗阻	1(0.88)
尿道感染	2(1.75)
肺部感染	1(0.88)
心血管意外	0
深静脉血栓	0
术后长期(术后1个月以后)
血清肿¹	3(2.63)
复发	0
穿刺孔疝	0
伤口延迟感染	1(0.88)
补片感染	0
肠梗阻	0
延迟性肠瘘	0
慢性疼痛	0
合计	20(17.54)

Please choose a citation manager

Content to export

Endoscopic totally extraperitoneal sublay repair for the treatment of ventral hernia

RichHTML

PDF (PC)

Knowledge