Minimally Invasive Stapled Abdominal Wall Repair: A New Surgical Technique.

IF 1.1 4区 医学 Q3 SURGERY
Gabriele Manetti, Maria Giulia Lolli, Elena Belloni, Giuseppe Nigri
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引用次数: 0

Abstract

Background: Diastasis recti (DR) is a common condition, especially in women after pregnancy, often associated with concomitant hernia defects and defined as a rupture of the midline and a separation of the rectus muscle more than 2 cm. Symptoms related to this are low back pain, urinary incontinence and pelvic prolapse, as well as abdominal bulging and core instability. We analyzed clinical and functional outcomes after treatment of DR alone or associated with midline hernias in 219 patients who underwent a midline reconstruction using miSAR® technique (minimally invasive stapled abdominal wall reconstruction). Methods: Between April 2019 and April 2022, 219 patients were treated with miSAR®. All patients were requested to quantify preoperative and postoperative functional symptoms (urinary incontinence, low back pain, abdominal swelling, and respiratory distress). Results: Twenty-seven men and 192 women underwent the miSAR® technique. The mean body mass index was 23.9 kg/m2. We performed the miSAR® technique in patients affected by incisional midline hernia and umbilical hernia alone or associated with DR. Composite mesh was used in 91.8% of cases. The average operating time was 90 minutes. Seven percent of the patients had postoperative complications, including two retromuscular hematomas, two retromuscular seromas, and one postoperative bleeding event. Two patients were readmitted for bowel obstruction. After surgery, there was symptomatic improvement in urinary incontinence, low back pain, respiratory symptoms, and abdominal swelling; this improvement was confirmed at 6 months and at 1- and 2-year follow-up. At the 1-year follow-up, the overall recurrence rate was 2.83%. Conclusion: miSAR® is a feasible and effective technique and shows promising results in the treatment of DR and ventral hernia. Possible enhancements include use of preoperative Botox to treat defects larger than 6 cm. Multicentric analysis is needed to validate the technique, and longer follow-up is required to assess the recurrence rate.

微创缝合腹壁修复术:一种新的外科技术
背景:直肠膨出(DR)是一种常见病,尤其是妊娠后的妇女,通常伴有疝气缺陷,定义为中线断裂和直肠肌分离超过 2 厘米。与此相关的症状有腰痛、尿失禁、骨盆脱垂以及腹部膨隆和核心不稳定。我们分析了 219 名接受 miSAR® 技术(微创缝合腹壁重建术)中线重建术的患者在治疗单纯 DR 或伴有中线疝后的临床和功能效果。研究方法2019年4月至2022年4月期间,219名患者接受了miSAR®治疗。要求所有患者量化术前和术后功能症状(尿失禁、腰背痛、腹部肿胀和呼吸困难)。结果:27 名男性和 192 名女性接受了 miSAR® 技术治疗。平均体重指数为 23.9 kg/m2。我们为单独或伴有DR的切口中线疝和脐疝患者实施了miSAR®技术。91.8%的病例使用了复合网片。平均手术时间为 90 分钟。7%的患者出现了术后并发症,包括2例肌后血肿、2例肌后血清肿和1例术后出血。两名患者因肠梗阻再次入院。术后,患者的尿失禁、腰背痛、呼吸道症状和腹部肿胀症状均有所改善;6 个月、1 年和 2 年的随访证实了这种改善。在 1 年的随访中,总复发率为 2.83%。结论:miSAR® 是一种可行且有效的技术,在治疗 DR 和腹股沟疝方面显示出良好的效果。可能的改进包括术前使用肉毒杆菌毒素治疗大于 6 厘米的缺损。需要进行多中心分析来验证该技术,并需要更长时间的随访来评估复发率。
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来源期刊
CiteScore
2.90
自引率
0.00%
发文量
163
审稿时长
3 months
期刊介绍: Journal of Laparoendoscopic & Advanced Surgical Techniques (JLAST) is the leading international peer-reviewed journal for practicing surgeons who want to keep up with the latest thinking and advanced surgical technologies in laparoscopy, endoscopy, NOTES, and robotics. The Journal is ideally suited to surgeons who are early adopters of new technology and techniques. Recognizing that many new technologies and techniques have significant overlap with several surgical specialties, JLAST is the first journal to focus on these topics both in general and pediatric surgery, and includes other surgical subspecialties such as: urology, gynecologic surgery, thoracic surgery, and more.
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