腹腔镜腹壁切口疝修补术并发症演变及防治

Advances of laparoscopic ventral incisional hernia repair and recognition of relative complications

腹腔镜腹壁切口疝修补手术随着术式的演变,在不同阶段有不同的并发症。经过近30年的发展,腹腔内修补技术相关并发症大多已得到解决,而补片相关并发症则越来越受到关注。规范化操作可以减少此类并发症的发生,目前研究的焦点是补片材料。腹膜外修补技术进展迅速,一直处于探索和发展阶段,有可能产生新的腹壁并发症。腹腔内和腹膜外修补术的原理、技术、并发症类型不同,适应人群也不相同。现代疝外科理念强调微创腹壁功能重建,腹腔内补片研发和腹膜外技术探索是减少并发症的关键,也是未来进展方向。机器人技术在减少腹腔和腹壁并发症方面逐渐体现出技术优势。可以预见,随着技术和材料的进展,基于微创技术的腹壁切口疝手术会拥有更佳的解决策略。

Different procedure-related complications appeared at different stages during the evolution of laparoscopic ventral and incision hernia repair.After almost30-year advances of intraperitoneal repair,most of the technique-related complications have been resolved.However,mesh-related complications have attracted more and more attention.Standardized operation could reduce the occurrence of such complications.Further research and development of mesh are the tasks of top priority.Endoscopic extraperitoneal ventral incisional hernia repair has developed rapidly in recent years,and procedures are getting mature gradually.But it is still in the era of exploration.The principles,techniques,types of complications of intraperitoneal and extraperitoneal repairs are different,and the indicated population is also different.Modern hernia surgery will focus on minimally invasive functional reconstruction of abdominal wall.The development of intraperitoneal meshes and the exploration of extraperitoneal techniques are two major kernels,which could reduce complications and witness great-leap-forward in the future.Robot-assisted surgery has demonstrated technical advantages in reducing complications of abdominal cavity and abdominal wall.With the advancement of techniques and materials,it is foreseeable that minimally invasive ventral and incisional hernia surgery will get better solving strategies.