ObjectiveTo evaluate the application value of three-dimensional visualization (3DV) technique in the reconstruction of complex abdominal incisional hernia. MethodsThe 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. ResultsA 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. ConclusionFrom 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.
目的探討腹壁大切口疝和巨大切口疝治療經驗。方法對我院采用補片行開放式腹壁大切口疝和巨大切口疝修補術的51例患者臨床資料進行回顧性分析。結果采用肌前補片修補法3例，肌肉間補片修補法3例，肌后腹膜前補片修補法39例，腹腔內補片修補法6例。 手術時間109～195 min，平均135.2 min; 術中出血15～90 ml，平均35.6 ml；術中無血管和內臟損傷等并發癥。 術后3～7 d（平均4.9 d）下床活動; 住院時間7～19 d，平均9.7 d。 2例患者術后出現漿液腫，經穿刺抽吸、負壓吸引和腹帶加壓包扎后治愈。51例患者隨訪12～36個月（平均24.5個月），3例（5.9%）患者復發，后行開放式腹腔內補片修補手術，恢復良好，無再復發。所有病例無慢性疼痛。結論應用補片行開放式腹壁大切口疝和巨大切口疝修補術是一種安全、可靠的方法，復發率低。
Objective To investigate and summarize preliminarily the clinical experiences of laparoscopic incisional hernia repair with intraperitoneal patch placement for the patients over 70 years old. Methods From July 2005 to July 2008, laparoscopic incisional hernia repair with intraperitoneal onlay meshes were applied in 8 patients, and whose clinical data were studied retrospectively. Results The procedures were performed successfully in all patients except one converted to open because of severe adhesion. The mean operative time was 105 min (ranged from 50 min to 180 min). One postoperative hypercapnia was resolved through mechanic ventilation for 24 h. One seroma and 1 prolonged postoperative pain over 1 month occurred, which were cured with conservative therapy. Mean postoperative hospital stay was 9.5 d (ranged from 7 d to 14 d). There was no recurrence or local discomfort during 12-36 months (average 26.5 months) follow-up.Conclusions Laparoscopic incisional hernia repair with intraperitoneal onlay mesh for the patients over 70 years old is safe and feasible, which has some advantages such as less trauma and rapid recovery. The perioperative management and operative technique are very important for the success of operation.