完全腔镜下腹直肌后修补术治疗中线腹壁疝的新尝试

Totally endoscopic sublay repair （TES） a novel approach to repair midline ventral hernia

目的探讨治疗中线腹壁疝的微创新方法——完全腔镜下腹直肌后修补（TES）。总结手术操作流程及技术细节，分析其安全性和有效性。方法2017年7至12月，11例中上腹部中线腹壁疝患者接受TES，术中置人大张网片加强修复。手术适应证：中上腹中线范围内的原发及继发性缺损，包括脐疝、腹直肌分离、中上腹白线疝及切口疝。TES的技术细节按照手术规范执行。结果11例手术均成功，无中转开放手术。平均手术时间120（80-205）min。术后伤口疼痛轻，术后第1天平均疼痛视觉模拟评分（VAS）2．5分（1-4分）。术后平均住院时间3．3（2-5）d。术后2例出现血清肿，由于处理妥当，未影响手术效果。术后随访时间1-6个月，未发现复发病例。结论TES手术安全可行，创伤少，无特殊器械的使用要求，可重复性高，且无需使用昂贵的防粘连补片，无需使用钉枪，大大节约医疗成本；是治疗中线腹壁疝的一种很好的技术补充。

Objective Investigating a novel approach to treat a midline ventral hernia totally endoscopic sublay repair （TES）. The procedure will be described in detail and the safety and efficacy evaluated. Methods During July and December 2017, eleven consecutive cases of primary and secondary epigastric midline ventral hernias were repaired using the TES procedure. A large mesh should be placed in the retrorectus position using this minimally invasive procedure. The indications for this procedure include umbilical, epigastric and incisional hernia equal in length to the rectus diastasis. Results All operations were successful without open conversion. The mean operation time was 120 mins （ 80 - 205 min ）, postoperative pain was mild and the mean VAS was 2.5 on first postoperative day. The average postoperative stay in hospital was 3.3 days （2 - 5 days）. 2 cases experienced postoperative seroma but without adverse effect on the final outcome and no recurrences during the follow-up period of 1 to 6 months. Conelusions TES procedure is safe, practical and minimally invasive requiring no specific device and highly reproducible. Besides there is no need for expensive anti-adhesion mesh and fixation tacker which make it more cost effective. TES is a good technique for the surgical treatment of midline ventral hernia.