1.中南大学湘雅医院，疝和腹壁外科中心;2.中南大学湘雅医院，普通外科;3.中南大学湘雅医院，国家老年疾病临床医学研究中心;4.湖南省浏阳市人民医院 胃肠外科;5.中南大学湘雅三医院 胃肠疝外科;6.湖南医药学院第一附属医院 普通外科;7.湖南省株洲市三三一医院 普通外科，湖南 株洲，412008;8.湖南省长沙市第一医院 普通外科;9.湖南中医药大学第二附属医院 普通外科;10.湖南省中医药大学第一附属医院 普通外科;11.湖南省益阳市人民医院 普通外科;12.湖南省长沙市第四医院 普通外科;13.湖南省湘潭市中心医院 普通外科
1.Hernia and Abdominal Wall Surgery Center, Xiangya Hospital, Central South University, Changsha 410008, China;2.Department of General Surgery, Xiangya Hospital, Central South University, Changsha 410008, China;3.National Clinical Medical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha 410008, China;4.Department of Gastrointestinal Surgery, the People's Hospital of Liuyang, Liuyang, Hunan 410314, China;5.Department of Gastrointestinal Hernia Surgery, the Third Xiangya Hospital, Central South University, Changsha 410013, China;6.Department of General Surgery, the First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan 418000, China;7.Department of General Surgery, 3, Zhuzhou, Hunan 412008, China;8.Hospital, Zhuzhou, Hunan 412008, China;9.Department of General Surgery, the First Hospital of Changsha, Changsha 410005, China;10.Department of General Surgery, the Second Hospital of Hunan University of Chinese Medicine, Changsha 410005, China;11.Department of General Surgery, the First Hospital of Hunan University of Chinese Medicine, Changsha 410007, China;12.Department of General Surgery, the People's Hospital of Yiyang, Yiyang, Hunan 413001, China;13.Department of General Surgery, the Fourth Hospital of Changsha, Changsha 410006, China;14.Department of General Surgery, Xiangtan Central Hospital, Xiangtan, Hunan 411199, China
背景与目的 腹壁疝修补术是最常见的外科手术之一，全球每年有200万例左右的腹壁疝患者接受手术治疗。与开放手术相比，腹腔镜下腹壁疝修补术优势明显。然而腹腔镜下腹腔内补片修补术（IPOM）与腹腔镜下腹膜外补片修补术（ESR）这两种腔镜术式的优缺点及疗效如何，尚无大样本的临床研究证实。因此，本研究通过比较ESR与IPOM两种手术方式治疗腹壁疝的近远期疗效，为临床提供循证参考。方法 回顾性分析2017年1月1日—2022年12月31日湖南省11家医疗机构收治的157例行腹腔镜腹壁疝修补术患者的临床资料，其中124例行ESR（ESR组），33例行IPOM（IPOM组），对比分析两组病例的临床特点、手术方式和术后近远期效果。结果 全组无中转开腹病例或围术期死亡病例。两组病例的年龄、性别、BMI、类型差异均无统计学意义（均P>0.05）。两组病例疝环横径、手术时间、术中出血量、疝环闭合概率差异均无统计学意义（均P>0.05）。网片固定方式ESR组以自固定和缝线固定为主（91.1%），而IPOM组以钉枪固定为主（69.7%），差异有统计学意义（P<0.05）。ESR组的术后疼痛评分明显低于IPOM组（2.4±0.8 vs. 2.8±1.0，P<0.05），住院费用明显低于IPOM组（21 001元vs. 38 437元，P<0.05）。两组的术后住院时间和近期并发症发生率差异无统计学意义（均P>0.05）。中位随访10.3个月，ESR组无复发病例，IPOM组2例复发（6.1%），差异有统计学意义（P<0.05）。结论 ESR是湖南地区腹腔镜下腹壁疝修补的主流术式之一。由于固定方式和网片选择的不同，ESR较之IPOM而言，术后疼痛更轻微、费用更低、复发率更低，且并不明显增加手术时间和术后近期并发症。
Background and Aims The ventral hernia repair surgery is one of the most common surgical procedures, with approximately two million cases of ventral hernia patients undergoing surgical treatment worldwide each year. Compared to open surgery, laparoscopic ventral hernia repair offers significant advantages. However, there is currently no large-scale clinical research confirming the advantages, disadvantages, and therapeutic effects of two laparoscopic techniques: intraperitoneal onlay mesh (IPOM) and extraperitoneal sublay repair (ESR) for repairing ventral hernias. Therefore, this study was conducted to compare the short- and long-term efficacy of ESR and IPOM in the treatment of ventral hernias, so as to provide evidence-based references for clinical practice.Methods The clinical data of 157 patients who underwent laparoscopic ventral hernia repair in 11 medical institutions in Hunan Province from January 1, 2017 to December 31, 2022 were retrospectively analyzed. Among them, 124 cases underwent ESR (ESR group) and 33 cases underwent IPOM (IPOM group). A comparative analysis was performed on the clinical characteristics, surgical methods, and short- and long-term postoperative outcomes of the two groups of patients.Results There were no cases of conversion to open surgery or perioperative deaths in the entire cohort. There were no statistically significant differences in age, gender, BMI, or hernia type between the two groups (all P>0.05). There were no statistically significant differences in hernia defect diameter, operative time, intraoperative blood loss, or hernia ring closure rate between the two groups (all P>0.05). In terms of mesh fixation methods, self-fixation and suture fixation were mainly used in the ESR group (91.1%), while helical tack fixation was mainly used in the IPOM group (69.7%), and the difference was statistically significant (P<0.05). The postoperative pain score in the ESR group was significantly lower than that in the IPOM group (2.37±0.82 vs. 2.76±1.00, P<0.05), and the hospitalization cost was significantly lower in the ESR group compared to the IPOM group (21 001 yuan vs. 38 437 yuan, P<0.05). There were no statistically significant differences in postoperative hospital stay and short-term complication rates between the two groups (all P>0.05). With a median follow-up of 10.3 months, there were no cases of recurrence in the ESR group, while the IPOM group had 2 cases of recurrence (6.1%), and the difference was statistically significant (P<0.05).Conclusion ESR is one of the main techniques for laparoscopic abdominal ventral repair in the Hunan region. Due to differences in fixation methods and mesh selection, ESR has advantages over IPOM, including milder postoperative pain, lower costs, and lower recurrence rates. Furthermore, it does not significantly increase operative time or the incidence of short-term postoperative complications.