Ventral hernia after high-intensity focused ultrasound ablation for uterine fibroids treatment:A case report

BACKGROUND High-intensity focused ultrasound(HIFU) ablation is a minimally invasive approach in gynecology that is used to manage uterine fibroids.Although this procedure is safe and effective,adverse outcomes are becoming a major problem.CASE SUMMARY We present a case of ventral hernia that occurred as a rare and delayed complication of HIFU ablation for uterine fibroids treatment.The patient came to the hospital with abdominal bloating that occurred 6 mo after ultrasound-guided HIFU ablation for managing uterine fibroids.The ventral hernia,which occurred due to atrophied muscle layers following the procedure,was confirmed by imaging studies and intraoperative findings.She required a hernia repair with mesh and hysterectomy for definitive treatment of uterine fibroid.CONCLUSION High-intensity ultrasound ablation should be performed only on appropriate candidates.Patients should be educated about potential complications of the procedure and the possibility of subsequent treatment.Post-procedural long-term follow-up for detecting delayed adverse effects is important.

Outcomes and complications of open, laparoscopic, and hybrid giant ventral hernia repair

BACKGROUND An incisional hernia is a common complication of abdominal surgery.AIM To evaluate the outcomes and complications of hybrid application of open and laparoscopic approaches in giant ventral hernia repair.METHODS Medical records of patients who underwent open,laparoscopic,or hybrid surgery for a giant ventral hernia from 2006 to 2013 were retrospectively reviewed.The hernia recurrence rate and intra-and postoperative complications were calculated and recorded.RESULTS Open,laparoscopic,and hybrid approaches were performed in 82,94,and 132 patients,respectively.The mean hernia diameter was 13.11±3.4 cm.The incidence of hernia recurrence in the hybrid procedure group was 1.3%,with a mean follow-up of 41 mo.This finding was significantly lower than that in the laparoscopic(12.3%)or open procedure groups(8.5%;P<0.05).The incidence of intraoperative intestinal injury was 6.1%,4.1%,and 1.5%in the open,laparoscopic,and hybrid procedures,respectively(hybrid vs open and laparoscopic procedures;P<0.05).The proportion of postoperative intestinal fistula formation in the open,laparoscopic,and hybrid approach groups was 2.4%,6.8%,and 3.3%,respectively(P>0.05).CONCLUSION A hybrid application of open and laparoscopic approaches was more effective and safer for repairing a giant ventral hernia than a single open or laparoscopic procedure.

Laparoscopic management of ventral hernia repair using intraperitoneal synthetic mesh: A 10-year retrospective observational study

Objective:Ventral hernia is an anterior abdominal wall hernia,with an incidence of 2%-13%.Laparoscopic ventral hernia repair is the preferred method worldwide with all the advantages of the laparoscopic technique proven to be an effective treatment option.This study aims to assess the long-term outcomes of laparoscopic management of ventral hernia repair using intraperitoneal onlay mesh(IPOM)or intraperitoneal onlay mesh with defect closure(IPOM PLUS)technique with the usage of variety of synthetic meshes intraperitoneally.Methods:A retrospective study of 821 patients of a single institution for a decade was conducted.Longterm outcomes such as pain,mesh infections,enterocutaneous fistula,bowel adhesions and recurrence were assessed.Results:There were 801 primary,12 incisional,and 8 recurrent hernia cases,including 532 females and 289 males with a mean age of 45.62±9.37 years.IPOM PLUS were underwent in 674(82.10%)cases.Polypropylene,dual,titanium,composite meshes were applied in 473(57.61%),208(25.33%),82(9.99%),and 58(7.06%)cases respectively.Intraoperative bleeding occurred in 3(0.37%)cases,seroma in 8(0.97%),wound infection in 4(0.49%),stitch abscess in 2(0.24%).Recurrence was found in 8(0.97%)cases,with 5 used polypropylene mesh and 3 used dual mesh.Mesh infections were discovered in 6(2.88%)cases used dual,and foreign body sensation in 4(0.85%)cases used polypropylene.Three(0.37%)patients had suture site hernia,and 3(0.37%)had chronic sinus.Conclusion:IPOM or IPOM PLUS holds good in small or medium sized ventral hernias.The safety and efficacy of intraperitoneal polypropylene mesh is comparable to that of other synthetic meshes.A mesh overlap of minimum 5 cm beyond defect edge is must to minimise hernia recurrence.Absorbable suture can be considered as alternative to tackers.

Evolution and advances in laparoscopic ventral and incisional hernia repair

Primary ventral hernias and ventral incisional hernias have been a challenge for surgeons throughout the ages. In the current era, incisional hernias have increased in prevalence due to the very high number of laparotomies performed in the 20 th century. Even though minimally invasive surgery and hernia repair have evolved rapidly, general surgeons have yet to develop the ideal, standardized method that adequately decreases common postoperative complications, such as wound failure, hernia recurrence and pain. The evolution of laparoscopy and ventral hernia repair will be reviewed, from the rectoscopy of the 4th century to the advent of laparoscopy, from suture repair to the evolution of mesh reinforcement. The nuances of minimally invasive ventral and incisional hernia repair will be summarized, from preoperative considerations to variations in intraoperative practice. New techniques have become increasingly popular, such as primary defect closure, retrorectus mesh placement, and concomitant component separation. The advent of robotics has made some of these repairs more feasible, but only time and well-designed clinical studies will tell if this will be a durable modality for ventral and incisional hernia repair.

腹腔镜腹壁切口疝修复术中腹壁功能重建

腹壁切口疝的治疗已从单纯的修补(repair)、加强(reinforcement)向重建(reconstruction)、重塑(restora⁃tion)和再生(regeneration)进展。腹壁切口疝有肌前、肌后、腹膜前、腹腔内等修补层次,均可通过开放或腹腔镜手术来完成。腹腔镜手术主要包括腹腔内补片修补术(IPOM)和微创非腹腔内补片修补术(MINIM)。无论哪种技术,既要遵循腹壁功能重建的原则,又要结合自身的微创特性,才能充分体现其临床价值。腹腔镜腹壁切口疝术中腹壁功能重建的核心可归纳为恢复腹壁解剖结构(Anatomy),保护腹壁生物力学(Biomechanics),维持腹壁顺应性(Compliance),提供机体整体动态活力(Dynamics)。

Laparoscopic Transabdominal Preperitoneal Repair of Spigelian Hernia: Case Report

Spigelian Hernia (SH) is an uncommon anterior abdominal wall defect, it represents 0.1% - 2% of all abdominal wall hernias. SHs have been traditionally repaired by open technique, but laparoscopic approaches are becoming more common and widely described in the literature. Here we present a case report of a 69-year-old woman who presented with abdominal pain, nausea, abdominal distention and absence of bowel movements for 2 days. A computed tomography performed in an external facility revealed a right-sided and incarcerated SH containing bowel and mesentery. The patient was treated surgically and the abdominal wall defect was repaired by a laparoscopic transabdominal preperitoneal (TAPP) approach. The patient was discharged 24 hours after surgery in excellent conditions. We hold that the TAPP approach is anatomically the soundest repair, with all the added benefits of minimally invasive surgery.

Robotic versus open transversus abdominis release and incisional hernia repair: A case-control study

Objective:Transversus abdominus release(TAR)is often required to achieve apposition of the rectus muscles and achieve wide mesh reinforcement of the abdominal wall.Traditionally,TAR has been done with an open technique(oTAR),and the benefits of the newer robotic approach(rTAR)has not been well established in the Australian setting.The aim of this study was to compare the results of oTAR with rTAR to demonstrate its safety and efficacy.Methods:A retrospective review of patients who underwent rTAR and oTAR at two tertiary hospitals was conducted between January 2018 and January 2020 in New South Wales,Australia.Patient demographics,perioperative and postoperative outcomes were compared in both groups.Results:There were 26 patients identified to have undergone TAR(13 rTAR,13 oTAR).Both groups were comparable in regards to age,sex and defect size.oTAR was associated with a higher American Society of Anaesthesiologist score.rTAR was associated with significantly longer average operative time(260.0±78.9 min vs.185.7±64.5 min,p=0.017)but found to have a significantly shorter length of stay(3.6±2.1 d vs.6.9±3.6 d,p=0.007)with a comparable complication rate.Conclusions:rTAR is associated with shorter length of hospital stay with comparable postoperative outcomes when compared to oTAR.We are seeing increasing evidence supporting the safety and benefits of robotics,however larger scale studies are required to fully understand this approach.

Abdominal wall hernia in a rural population in India—Is spectrum changing?

Hernia is a common word that most surgeons are familiar with. A retrospective study was planned to analyse the spectrum of abdominal wall hernias in a rural population inIndia. Majority of the patients were of 40 - 70 yrs. Male to female ratio was 7:1. Incidence of groin hernias showed an increasing trend with advancing age. Out of total 320 cases, inguinal hernias were predominating in 77.81% cases. Ventral hernias were present in about 18% cases. However, femoral hernias were rare. We concluded that spectrum of abdominal wall hernias is almost the same all over the globe despite having differences in their socioeconomic and educational status.

Role of botulinum toxin a in the management of complex incisional hernias

Despite the technological breakthroughs and discover of abdominal meshes, ventral hernia has always been challenging in therapeutic strategies by the surgeons, with high recurrence rates. The use of botulinum toxin A (BTA) for the management of ventral and incisional hernia (IH) poses an increasingly interesting practice, especially for the intimidating complex one. The preoperative administration of the toxin to the lateral abdominal muscles by use of Ultra-Sound guidance causes muscle paralysis and a reduction of intraabdominal pressure. Thus, the hernia defect can be primarily closed without tension, if the length of the defect is up to 10 cm. In larger hernia, this method can be combined with component separation techniques or the use of a mesh. The mesh placement seems to be better by laparoscopy. The site of injection and the dosage of BTA are still under discussion amongst authors. The optimal administration is proposed by some authors to be at least 2 weeks before repair. There is also an analgesic effect of BTA to the patients that underwent hernia reconstruction. Ultimately, the role of BTA in the reconstruction of ventral hernia seems to be promising, but there is a necessity for several randomized clinical trials.

腹腔镜下腹壁肌后修补术治疗腹壁疝疗效分析

目的:探讨应用腹腔镜下腹壁肌后修补术(ESR)治疗腹壁疝的临床疗效。总结手术操作步骤及相关技术要点,分析其临床应用效果和价值。方法:选取2017年11月—2019年10月淄博市中心医院、淄博市市立医院收治的26例应用ESR手术治疗的腹壁疝患者,手术操作均按照手术规范执行。结果:26例患者在腹腔镜下腹壁肌后放置补片加强修补,手术过程顺利,无1例中转开放。手术时间为(125.6±33.24)min。术后第2 d开始进食。术后72 h视觉模拟疼痛评分(VAS)为(2.26±0.92)分。住院时间为(5.92±1.87)d。术后18例放置闭式负压引流管,时间为(6.22±3.67)d。术后早期疼痛不适3例,早期出现腹胀不适2例,浅表手术部位切口感染1例,术区出现血清肿3例,均经非手术治疗后好转。术后随访患者时间为(4.42±2.08)个月,无疝复发、出血、补片感染、肠瘘、慢性疼痛(VAS>3分,时间>3个月)等严重并发症。结论:ESR手术在治疗腹壁疝方面安全有效,患者术后恢复快,具有较高的临床应用价值。

内镜下全内脏囊分离技术与腹腔镜下腹腔内补片修补术在腹壁疝中的比较

目的:比较分析内镜下全内脏囊分离技术(TVS)与腹腔镜腹腔内补片修补术(IPOM)在腹壁疝中的应用特点,总结TVS技术的安全性、经济性和有效性。方法:回顾性分析2019年10月至2021年10月在浙江大学医学院附属金华医院疝与腹壁外科行腹壁疝修补术的56例患者资料,其中27例接受TVS技术修补(TVS组),29例接受IPOM术(IPOM组)。比较2组患者的特点、手术时间等围手术期资料,采用电话或门诊方式进行随访。结果:2组患者的年龄、性别、BMI及缺损面积等基线资料差异无统计学意义(P>0.05)。TVS组的手术时间[(216.93±52.80)min]较IPOM组[(187.17±40.73)min]延长(P=0.021)。TVS组术后第1天平均视觉模拟评分(VAS)较IPOM组小(P=0.003),住院费用也较IPOM组明显降低(P<0.001),术后住院时间差异无统计学意义(P=0.067)。其中TVS组中有2例因腹膜前建腔失败和前缺损关闭困难而中转,IPOM组有1例术后手术区域感染,经穿刺引流后治愈。随访时间截至2022年3月,术后随访时间平均14个月,随访率94.6%。随访期间,TVS组有1例复发,余未见复发和死亡病例。结论:TVS技术在腹壁疝修补术中是安全可行的。虽手术时间长,但减少了术后疼痛,节省了医疗成本,是治疗腹壁疝的一种很好的技术补充。

右美托咪定滴鼻联合艾司氯胺酮麻醉对腹腔镜疝手术患儿的镇痛效果

目的 探讨右美托咪定滴鼻联合艾司氯胺酮麻醉对腹腔镜疝手术患儿的镇痛效果。方法 选取2019年4月至2021年4月在焦作市妇幼保健院行腹腔镜疝手术治疗的80例腹股沟疝患儿,采用随机数字表法分为两组,各40例。对照组接受艾司氯胺酮滴鼻,观察组在对照组的基础上接受右美托咪定,而后两组均进行实施全身麻醉。比较两组麻醉苏醒后15 min、6 h、12 h的疼痛程度[采用视觉模拟评分法(VAS)评估];比较两组拔管、苏醒及麻醉复苏室停留时间;于麻醉苏醒后15 min时比较两组患儿躁动发生情况[采用苏醒期躁动评分表(PAED)评估]。结果 麻醉苏醒后15 min、6 h、12 h,两组VAS评分均有所升高,但与对照组比较,观察组各时点VAS评分均低(P<0.05);与对照组比较,观察组拔管时间、苏醒时间及麻醉复苏室停留时间均较短(P<0.05);麻醉苏醒后15 min时,观察组患儿躁动发生率低于对照组(P<0.05)。结论 右美托咪定滴鼻、艾司氯胺酮麻醉二者联用可提高腹腔镜疝手术患儿镇痛效果,缩短拔管、苏醒及麻醉复苏室停留时间,减少患儿苏醒期躁动发生。

腹腔镜或杂交技术修补大型、巨大型腹壁切口疝的技巧

目的探讨腹腔镜或杂交技术修补大型(缺损8~12 cm)、巨大型(缺损>12 cm)腹壁切口疝的操作技巧。方法 2009年7月~2015年6月,对45例腹壁切口疝进行修补,包括大型20例,巨大型25例。腹腔镜修补20例,杂交修补25例,均使用防粘连补片。结果腹腔镜修补和杂交修补手术的手术时间分别为(113.0±35.4)min、(127.0±31.6)min,术中出血(36.0±19.8)ml、(92.0±36.2)ml,术后住院时间(10.3±2.6)d、(11.0±2.2)d。无手术死亡、腹腔感染、切口感染发生,1例左下肢深静脉血栓形成经抗凝与活血化瘀治愈,2例切口血清肿穿刺加压包扎治愈,3例持续腹壁痛3个月后缓解。随访1~5年,(3.1±1.8)年,无疝复发。结论腹腔镜或杂交技术防粘连补片修补切口疝,具有创伤小、恢复快、复发率低等优点。操作时避免肠管损伤、修复腹壁缺损或封闭疝环、选择合适补片、可靠固定是关键。

MSCT诊断易嵌顿并发肠梗阻腹外疝的临床应用价值

目的探讨易嵌顿并发肠梗阻腹外疝的多层螺旋CT表现及临床应用价值。方法回顾分析24例经手术证实腹外疝并发肠梗阻的螺旋CT表现。结果 24例中,根据疝所在的位置,螺旋CT诊断腹股沟斜疝16例(右侧10例、左侧6例),腹股沟直疝1例,股疝3例(右侧2例、左侧1例),闭孔疝2例(右侧),腹壁切口疝2例。疝囊内容物均为小肠,伴大网膜7例(腹股沟斜疝6例、腹股沟直疝1例)。小肠不全梗阻11例,完全性梗阻13例,腹腔积液3例。结论多层螺旋CT不仅能明确腹外疝并发肠梗阻的部位及程度,而且能为临床提供疝内容物的种类、大小、与周围解剖关系等精细信息,对临床选择合理的治疗方案及患者预后具有重要价值。

异体腹直肌前鞘细胞外基质框架用于疝修补

目的 探讨异体腹直肌前鞘细胞外基质框架 (ASECM )作为疝修补材料的效果。方法 12只犬随机分为 2组 :(1)ASECM修补组 (实验组 ) ,6只 ;(2 )人工材料修复组 (对照组 ) ,6只。手术于腹直肌左右侧腹壁制成一 3cm× 5cm的缺损区 ,右侧缺损区实验组用ASECM行修补 ,对照组用人工材料补片修补。左侧缺损区不作修补用作自体对照。两组分别于术后2 ,8,16周取材行光镜、免疫组化、扫描及透射电镜检查。结果 两组动物左侧腹壁缺损处 2d后出现腹壁疝 ,而修补区均未出现腹壁疝。实验组光镜检查显示 ,术后 2～ 8周ASECM中长入的宿主成纤维细胞逐渐增多 ,术后 16周时成纤维细胞数量减少。各时期均无明显的炎性细胞浸润。实验组电镜检查术后 16周修补局部基本为排列整齐的细胶原。对照组光镜检查显示 ,术后 2～ 16周时可见由少量～大量的成纤维细胞附于材料层面上 ,但人工材料网丝间隙之间未见明显的成纤维细胞生长。且在各个时期均有炎性细胞浸润。术后 16周对照组电镜检查时 ,成纤维细胞生长出的突起包饶材料表面 ,类似宿主对异物组织的包裹反应 ,且人工材料补片未与宿主组织融合。免疫组化检查显示为I ,III型胶原。结论 ASECM为机体提供了一良好的供宿主成纤维细胞“爬行替代”的框架 。

无张力疝修补术治疗腹壁切口疝的临床应用

目的 探讨腹壁切口疝的手术方式。方法 应用人工合成材料行腹壁切口疝的无张力修补术。结果 本组32例患者因各种原发疾病经外科手术后发生腹壁切口疝,其中13例经传统的手术缝合1次以上而复发,均采用本方法手术。治愈31例,治愈率96 .87% ,复发1例,复发率3.13%。结论 腹壁切口疝是腹部手术后的常见并发症,多见于老年患者;使用人工合成材料作腹壁切口疝的无张力疝修补术效果确切。

开放式合成材料补片修补腹壁疝217例的经验总结

目的:评价开放的合成材料补片修补腹壁疝的效果和并发症。方法:回顾性分析1999年4月至2008年4月行此法修补之腹壁疝217例的临床资料,包括切口疝184例和脐疝33例。应用肌前修补法(onlay法)59例,肌后修补法(sublay法)84例,腹腔内补片修补法(IPOM法)74例。198例病人获得随访,时间为4～108个月,平均57个月。结果:术后血清肿发生率为5.5%,(12/217),onlay组血清肿发生率显著高于sublay组(P<0.05),而与IPOM组无显著差别。总切口感染率为1.4%(3/217),各组间切口感染率无显著差别。术后总复发率为3.0%(6/198),onlay组术后复发率显著高于sublay组和IPOM组(分别P<0.05)。结论:开放式合成材料补片修补腹壁疝是安全有效的外科治疗方法,其中以sublay法更为合理。

腹腔镜腹壁切口疝补片修补术的应用体会

目的：探讨腹腔镜腹壁切口疝补片修补术的临床应用价值及安全性。方法：2005年8月至2006年10月我院为8例腹壁切口疝患者使用自膨胀式聚丙烯-膨化聚四氟乙烯双面复合型补片行腹腔镜腹壁切口疝修补术，其中2例联合行胆囊切除术。结果：8例手术均获成功，手术时间55～150min，平均85min，无手术死亡病例及并发症发生，患者术后8～24h后下床活动，1—2d排气，术后疼痛轻，2—3d后完全缓解，3—7d（平均4d）患者顺利康复出院。随访12～24个月无复发。结论：腹腔镜腹壁切口疝修补术安全可靠，具有创伤小、术后康复快、并发症少、不增加手术穿刺孔、可完成联合手术等优点，临床应用前景广阔。

腹腔镜与开放式巨大腹壁切口疝补片修补术的对比分析

目的：比较开放手术及腹腔镜补片修补巨大腹壁切口疝的手术效果。方法：回顾分析我院2003年1月至2007年6月收治的43例巨大腹壁切口疝患者的临床资料。根据手术方式分为腹腔镜组（16例）和开放组（27例），对两组手术时间、术后并发症、术后住院时间等进行对比分析。结果：两组手术时间、术后并发症发生率无明显差异。开放手术组2例发生切口感染，1例经冲洗引流2个月治愈，男1例再次手术取出补片。腹腔镜手术组术后住院时间和手术出血量明显少于开放手术组。术后随访4～48个月，平均21个月，两组均无复发病例。结论：腹腔镜下应用补片修补巨大腹壁切口疝同样安全、合理，且具有患者创伤小、康复快和术后住院时间短等优点。

婴幼儿先天性胸腹裂孔疝的手术治疗

目的探讨婴幼儿先天性胸腹裂孔疝的治疗方法,提高生存率。方法回顾我院1986～2003年收治16h～2岁先天性胸腹裂孔疝53例的手术治疗,其中5例经胸手术,48例经腹手术。结果治愈47例熏死亡6例。随访30例2月～10年,X线透视肺膨胀良好,术后早期体重增加,呼吸道感染明显减少。结论提高诊断、急救技术,完善新生儿围手术期措施,可提高婴幼儿先天性胸腹裂孔疝的生存率。