Application efficacy of "multidimensional suture" technique in laparoscopic repair of giant incisional hernia
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Department of Gastrointestinal and Hernia Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University/Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases/National Key Clinical Specialized Department, Guangzhou 510655, China

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R656.2

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    Abstract:

    Background and Aims The repair of giant incisional hernia is a difficult surgical procedure in the practice of hernia and abdominal wall surgery, especially for the problem of suture and closure of the fascia defect. At present, the suture method commonly used in clinical practice is often faced with many problems in repairing giant incisional hernia, such as excessive tension and unobliterated dead space. Based on the development of suture materials, the authors' team has previously developed a new suture technique- "multidimensional suture", and use of this technique in incisional hernia repair can effectively solve the above problems. This study was performed to demonstrate the clinical value of "multidimensional suture" technique in giant incision hernia repair by comparing its clinical efficacy with that of conventional suture technique in laparoscopic repair of large incisional hernia.Methods The data of patients with giant incisional hernia who underwent laparoscopic intraperitoneal onlay mesh repair for giant incision hernia in the Department of Gastrointestinal and Hernia Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University from January 2018 to June 2020 were retrospectively analyzed. Of the patients, 43 cases received “multidimensional suture” for the treatment of hernia sac and defect (study group), and 36 cases underwent the conventional suture method for the closure of defect (control group). The main clinical variables were compared between the two groups of patients.Results No open conversion was needed and the fascia defects were completely closed in all patients in study group, while, 7 patients (19.44%) were converted to open surgery and complete defect closure failed in 5 patients (13.89%) in control group. The open conversion rate and incidence of failed complete defect closure were significantly different between the two groups (P=0.003, P=0.017). The average time of fascia defect closure, the average operative time and the average intraoperative blood loss were (89.84±15.29) min, (181.51±18.23) min, and (26.84±12.67) mL for study group, and were (61.28±14.09) min, (157.72±19.17) min, and (27.25±11.83) mL for control group, respectively. The difference between the two groups had statistical significance in time of fascia defect closure and operative time (both P<0.001), and had no statistical significance in intraoperative blood loss (P=0.871). The incidence of postoperative surgical site occurrences (SSO) in study group was significantly lower than that in control group (2.33% vs. 16.77%, P=0.043), while there was no statistical difference in postoperative recurrence rates between two groups (0 vs. 2.78%, P=0.456). The postoperative time to ambulation, the length of postoperative hospital stay and hospitalization cost were (22.36±4.45) h, (5.23±1.26) d, and (75 924.21±6 065.61) yuan for study group, and (22.92±5.15) h, (5.46±1.93) d, and (74 185.99±5 476.48) yuan for control group, respectively. No significant differences in these 3 variables were noted between the two groups (P=0.192, P=0.440, P=0.283).Conclusion The application of "multidimensional suture" technique in giant incision hernia repair can decrease the conversion rate to open surgery, effectively close the fascia defect, and reduce the risk of postoperative surgical site occurrence.

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HOU Zehui, YU Zhuomin, LIANG Zhiqiang, ZHOU Taicheng, LI Yingru, ZENG Bin, CHEN Shuang, JIANG Zhipeng. Application efficacy of "multidimensional suture" technique in laparoscopic repair of giant incisional hernia[J]. Chin J Gen Surg,2022,31(4):465-473.
DOI:10.7659/j. issn.1005-6947.2022.04.008

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History
  • Received:March 03,2022
  • Revised:April 08,2022
  • Adopted:
  • Online: May 07,2022
  • Published: