Application of three-dimensional visualization technique in complex abdominal incisional hernia: an experience of 48 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PENG Xuefeng ^1,2 , YANG Hua ² , LI Hui ² ,  SONG Yinghan ^3,4 , ZHANG Yuchen ³ , LEI Wenzhang ^1,4

1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;
3. Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
4. Department of Gastrointestinal Surgery, West China Tianfu Hospital, Sichuan University, Chengdu 610213, P. R. China;

Corresponding?author：

SONG Yinghan, Email: yinghan2222@163.com

Keywords：

three-dimensional visualization technology; complex abdominal incisional hernia

DOI：

10.7507/1007-9424.202402054

Video：

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Objective To evaluate the application value of three-dimensional visualization (3DV) technique in the reconstruction of complex abdominal incisional hernia. Methods The clinical data of the patients with complex abdominal incisional hernia admitted to the West China Hospital of Sichuan University from September 2021 to September 2022 were collected. The area of abdominal wall defects was analyzed by Medraw software and reconstructed using 3DV technique, then the classifying and partition of abdominal wall defects were performed, the hernia sac/ intraabdominal volume ratio was calculated, patch size was estimated, and intraabdominal pressure values at 24 h and 48 h after surgery as well as operation time, complications were recorded. Results A total of 48 patients with complex abdominal incisional hernia were enrolled, including 30 cases of midline abdominal incisional hernia and 18 cases of other sites. There were 13 cases of moderate hernia, 19 cases of large hernia, and 16 cases of huge hernia. The abdominal wall defect area measured by 3DV technique for the 48 patients was (92.11±60.25) cm², the hernia sac / intraabdominal volume ratio was (7.7±5.2)%, and the actual defect area measured intraoperatively was (89.20±57.38) cm². Pearson correlation analysis showed a positive correlation between the preoperative 3DV measurement and intraoperative measurement (r=0.959, P<0.001). The operation time was (73.5±8.2) min, postoperative anal exhaust time (31.66±15.32) h, intraabdominal pressures at 24 h and 48 h postoperatively were (13.50±2.12) mmHg and (11.39±1.42) mmHg, respectively. The patient’s hospitalization time was (7.12±1.21) d. Among the 48 patients, 7 cases (14.58%) experienced complications after surgery, recovered smoothly after conservative treatment and no unplanned reoperation was required. All patients were followed up for 18–32 months with a median time of 26 months, and no long-term hernia recurrence was observed. Conclusion From the analysis results of this study, it can be seen that the application of 3DV technique to evaluate complex abdominal wall defects can assist hernia surgeons to make a correct choice and has a better safety and effect.

Citation： PENG Xuefeng, YANG Hua, LI Hui, SONG Yinghan, ZHANG Yuchen, LEI Wenzhang. Application of three-dimensional visualization technique in complex abdominal incisional hernia: an experience of 48 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(8): 928-932. doi: 10.7507/1007-9424.202402054 Copy

1.	Song Z, Dong W, Yang D, et al. Application of 3D visualization technology in complex abdominal wall defects. Int J Gen Med, 2021, 14: 2449-2457.
2.	林佳鑫, 刁德昌, 廖偉林, 等. CT三維重建及3D打印技術在復雜的腹膜后腫瘤手術中的應用. 結直腸肛門外科, 2022, 28(2): 119-123.
3.	原珍團, 鄧開鴻, 余建群, 等. 腹壁疝的螺旋CT表現及臨床應用. 華西醫學, 2009, 24(9): 2378-2380.
4.	楊碩, 陳杰. 復雜腹壁疝治療相關要點. 中國實用外科雜志, 2021, 41(4): 387-391.
5.	黃鶴光, 林榮貴. 腹壁疝的規范化治療. 中國普外基礎與臨床雜志, 2018, 25(12): 1413-1415.
6.	劉飛德, 李基業, 姚勝, 等. 腹壁疝補片修補術后感染的外科處理. 中國普外基礎與臨床雜志, 2011, 18(12): 1292-1295.
7.	中華醫學會外科學分會疝與腹壁外科學組, 中國醫師協會外科醫師分會疝和腹壁外科醫師委員會. 腹壁切口疝診斷和治療指南(2018年版). 中華外科雜志, 2018, 56(7): 499-502.
8.	潘麗杰, 孫麗萍, 馬清蕓, 等. 間接腹腔壓力監測在重癥監護中的應用. 青海醫藥雜志, 2007, 37(4): 55-56.
9.	李雯莉, 曹務騰, 王馨華, 等. 漸進性人工氣腹前后基于3D精準容積重建術前“透視”腹壁疝. 影像研究與醫學應用, 2019, 3(20): 14-16.
10.	陳杰, 秦昌富, 申英末. 主動減容手術在巨大腹壁疝治療中的應用和進展. 中華消化外科雜志, 2016, 15(10): 950-953.
11.	李紹杰, 孟云瀟, 李紹春, 等. 腹膜腱膜瓣加強補片修補技術用于腹壁切口疝手術158例報告. 中國實用外科雜志, 2021, 41(4): 398-401.
12.	馬寧, 湯福鑫, 黃恩民, 等. “對位對線”補片固定法在腹腔鏡切口疝修補術中的應用. 中國普通外科雜志, 2022, 31(4): 474-480.
13.	樂飛, 李健文. 微創腹壁切口疝的術式進展、爭議和展望. 外科理論與實踐, 2020, 25(3): 198-201.
14.	Brophy SA, Minor S, French DG. Abdominal compartment syndrome following paraesophageal and diaphragmatic hernia repair. ACG Case Rep J, 2024, 11(5): e01344. doi: 10.14309/crj.0000000000001344.
15.	Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on intra-abdominal hypertension and abdominal compartment syndrome. Ⅰ. Definitions. Intensive Care Med, 2006, 32(11): 1722-1732.
16.	李基業. 巨大腹壁切口疝的現代外科治療. 中國普外基礎與臨床雜志, 2003, 10(1): 10-12.
17.	麥麥提艾力·麥麥提明, 玉素甫, 克力木. 腹腔容積測定在巨大疝治療及其相關并發癥中的意義. 中華普通外科雜志, 2017, 32(7): 634-636.
18.	湯福鑫, 李英儒, 楊偉勝, 等. 術前漸進性氣腹在老年腹壁巨大切口疝修補術中的應用價值. 中華疝和腹壁外科雜志(電子版), 2019, 13(2): 105-110.
19.	杜宇, 侯清. 巨大腹壁疝修補術中應用主動減容手術對腹腔內高壓及預后的影響. 中華疝和腹壁外科雜志(電子版), 2019, 13(4): 365-368.
20.	李炎銘, 劉軍偉, 梁鑫鴻, 等. 立體縫合技術在腹腔鏡巨大切口疝修補術中的應用效果研究. 浙江創傷外科, 2023, 28(4): 780-783.
21.	Michael LL, Hego N, Mahmoud M, et al. Enterocutaneous fistula from a mesh eroding the small bowel after incisional hernia repair: a case report. Internation J Abdomin Wall Hernia Surg, 2023, 6(1): 48-52 .

1. Song Z, Dong W, Yang D, et al. Application of 3D visualization technology in complex abdominal wall defects. Int J Gen Med, 2021, 14: 2449-2457.
2. 林佳鑫, 刁德昌, 廖偉林, 等. CT三維重建及3D打印技術在復雜的腹膜后腫瘤手術中的應用. 結直腸肛門外科, 2022, 28(2): 119-123.
3. 原珍團, 鄧開鴻, 余建群, 等. 腹壁疝的螺旋CT表現及臨床應用. 華西醫學, 2009, 24(9): 2378-2380.
4. 楊碩, 陳杰. 復雜腹壁疝治療相關要點. 中國實用外科雜志, 2021, 41(4): 387-391.
5. 黃鶴光, 林榮貴. 腹壁疝的規范化治療. 中國普外基礎與臨床雜志, 2018, 25(12): 1413-1415.
6. 劉飛德, 李基業, 姚勝, 等. 腹壁疝補片修補術后感染的外科處理. 中國普外基礎與臨床雜志, 2011, 18(12): 1292-1295.
7. 中華醫學會外科學分會疝與腹壁外科學組, 中國醫師協會外科醫師分會疝和腹壁外科醫師委員會. 腹壁切口疝診斷和治療指南(2018年版). 中華外科雜志, 2018, 56(7): 499-502.
8. 潘麗杰, 孫麗萍, 馬清蕓, 等. 間接腹腔壓力監測在重癥監護中的應用. 青海醫藥雜志, 2007, 37(4): 55-56.
9. 李雯莉, 曹務騰, 王馨華, 等. 漸進性人工氣腹前后基于3D精準容積重建術前“透視”腹壁疝. 影像研究與醫學應用, 2019, 3(20): 14-16.
10. 陳杰, 秦昌富, 申英末. 主動減容手術在巨大腹壁疝治療中的應用和進展. 中華消化外科雜志, 2016, 15(10): 950-953.
11. 李紹杰, 孟云瀟, 李紹春, 等. 腹膜腱膜瓣加強補片修補技術用于腹壁切口疝手術158例報告. 中國實用外科雜志, 2021, 41(4): 398-401.
12. 馬寧, 湯福鑫, 黃恩民, 等. “對位對線”補片固定法在腹腔鏡切口疝修補術中的應用. 中國普通外科雜志, 2022, 31(4): 474-480.
13. 樂飛, 李健文. 微創腹壁切口疝的術式進展、爭議和展望. 外科理論與實踐, 2020, 25(3): 198-201.
14. Brophy SA, Minor S, French DG. Abdominal compartment syndrome following paraesophageal and diaphragmatic hernia repair. ACG Case Rep J, 2024, 11(5): e01344. doi: 10.14309/crj.0000000000001344.
15. Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on intra-abdominal hypertension and abdominal compartment syndrome. Ⅰ. Definitions. Intensive Care Med, 2006, 32(11): 1722-1732.
16. 李基業. 巨大腹壁切口疝的現代外科治療. 中國普外基礎與臨床雜志, 2003, 10(1): 10-12.
17. 麥麥提艾力·麥麥提明, 玉素甫, 克力木. 腹腔容積測定在巨大疝治療及其相關并發癥中的意義. 中華普通外科雜志, 2017, 32(7): 634-636.
18. 湯福鑫, 李英儒, 楊偉勝, 等. 術前漸進性氣腹在老年腹壁巨大切口疝修補術中的應用價值. 中華疝和腹壁外科雜志(電子版), 2019, 13(2): 105-110.
19. 杜宇, 侯清. 巨大腹壁疝修補術中應用主動減容手術對腹腔內高壓及預后的影響. 中華疝和腹壁外科雜志(電子版), 2019, 13(4): 365-368.
20. 李炎銘, 劉軍偉, 梁鑫鴻, 等. 立體縫合技術在腹腔鏡巨大切口疝修補術中的應用效果研究. 浙江創傷外科, 2023, 28(4): 780-783.
21. Michael LL, Hego N, Mahmoud M, et al. Enterocutaneous fistula from a mesh eroding the small bowel after incisional hernia repair: a case report. Internation J Abdomin Wall Hernia Surg, 2023, 6(1): 48-52 .

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of three-dimensional visualization technique in complex abdominal incisional hernia: an experience of 48 cases

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