A retrospective cohort study of laparoscopic enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) repair of incisional ventral hernias in patients with morbid obesity.
Shlomi Rayman, Mohamad Molham, Ran Orgad, Hana Gelman, Eliyahu Gorgov, Youri Mnouskin
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引用次数: 0
Abstract
Background: Incisional hernia (IH) repair in morbidly obese (MO) patients poses significant challenges due to higher risks of complications and recurrence. Traditional open repairs are linked to increased morbidity, driving interest in minimally invasive techniques. The enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) technique shows promise as a laparoscopic method for IH repair, but data on its efficacy and safety in MO patients are limited. This study aims to evaluate the efficacy, safety, and feasibility of the eTEP-RS approach specifically for IH repair in this high-risk population.
Methods: Analysis of a retrospective cohort of consecutive patients undergoing laparoscopic eTEP-RS for IH repair between 2017 and 2022 which included 135 patients, categorized into two groups based on body mass index (BMI): the MO group (BMI > 35 kg/m2) and the control group (BMI ≤ 35 kg/m2). We compared demographics, comorbidities, hernia characteristics, intra-operative data, post-operative outcomes, and hernia recurrence rates.
Results: Patients in the MO group had significantly more type 2 diabetes mellitus (n = 18, 51% vs n = 25, 25%; p = 0.004), hypertension (n = 35, 73% vs n = 75, 53%; p = 0.017), dyslipidemia (n = 29, 60% vs n = 58, 41%; p = 0.021), ASA score 3 (n = 18, 52% vs n = 23, 23%; p = 0.004), a history of previous umbilical hernia repair (n = 13, 27% vs n = 13, 9.2%; p = 0.002), and bariatric surgery (n = 10, 29% vs n = 13, 13%; p = 0.035). There were no differences in intra-operative characteristics, operative times, or intra-operative complications between groups. During a median follow-up period of 1 year (IQR 40-680 days), there were no differences in hernia recurrence (n = 2, 5.7% vs n = 9, 9%; p = 0.07), time to recurrence, or chronic analgesia usage between groups.
Conclusion: The laparoscopic eTEP-RS approach was safe and effective for IH repair in patients with MO, demonstrating comparable post-operative outcomes and recurrence rates to those with a lower BMI in a selected cohort of patients.
背景：病态肥胖（MO）患者的切口疝（IH）修复面临着巨大的挑战，因为并发症和复发的风险较高。传统的开放式修复与发病率增加有关，这推动了人们对微创技术的兴趣。增强视野完全腹膜外Rives-Stoppa （eTEP-RS）技术有望作为一种腹腔镜IH修复方法，但其在MO患者中的有效性和安全性数据有限。本研究旨在评估eTEP-RS方法在高危人群中修复IH的有效性、安全性和可行性。方法：回顾性分析2017 - 2022年间连续行腹腔镜eTEP-RS修复IH的患者，共纳入135例患者，根据体重指数（BMI）分为两组：MO组（BMI≤35 kg/m2）和对照组（BMI≤35 kg/m2）。我们比较了人口统计学、合并症、疝气特征、术中数据、术后结果和疝气复发率。结果：MO组患者2型糖尿病发生率明显高于对照组(n = 18, 51% vs n = 25, 25%；p = 0.004)、高血压(n = 35岁,73% vs n = 75, 53%;p = 0.017),血脂异常(60% vs n = n = 29日,58岁的41%;p = 0.021),亚撒的分数3 (52% vs n = n = 18日,23岁的23%;P = 0.004)，既往脐疝修补史(n = 13.27% vs n = 13.9.2%；P = 0.002)和减肥手术(n = 10.29% vs n = 13.13%；p = 0.035)。两组间术中特征、手术时间及术中并发症无差异。在中位随访1年（IQR 40-680天）期间，两组疝气复发率无差异(n = 2,5.7% vs n = 9,9%；P = 0.07)、复发时间、慢性镇痛药使用情况。结论：在选定的患者队列中，腹腔镜eTEP-RS方法对MO患者的IH修复是安全有效的，其术后结果和复发率与BMI较低的患者相当。
期刊介绍：
Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research.
Topics covered in the journal include:
-Surgical aspects of:
Interventional endoscopy,
Ultrasound,
Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology,
-Gastroenterologic surgery
-Thoracic surgery
-Traumatic surgery
-Orthopedic surgery
-Pediatric surgery
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