Experience Of 41 Cases Of Laparoscopic Open Hybrid Technique In The Treatment Of Abdominal Incisional Hernia

Objective:To discuss the advantage and experience of hybrid technique in the treatment of abdominal incisional hernia.Methods:The clinical data of 41 patients with abdominal incisional hernia treated by hybrid technique from September 2011 to June 2017 were retrospectively analyzed.The clinical data was collected including:(1)Condition of abdominal pressure increasing disease;(2)Surgical history;(3)Type and diameter of incisional hernia;(4)Reason of hybrid surgery;(5)Surgical data(Patch size,operation time,VAS score of 48 hours aftet operation,postoperative hospital stay,condition of indwelling drainage);(6)Follow-up data(Postoperative pain,seroma,intestinal injury,intestinal fistula,incision infection,patch infection,celiac septal syndrome,recurrence).Result:(1)Condition of abdominal pressure increasing disease: chronic cough(n=1,2.4%),chronic constipation(n=3,7.3%),benign prostatic hyperplasia(n=4,9.8%),non-complication:(n=33,80.5%).(2)Surgical history: There were nine cases(21.9%)of biliary tract operation,nine cases(21.9%)of hysterectomy / ovariectomy,fourteen cases(34.2%)of gastrointestinal operation,four cases(9.8%)of enterostomy and five cases(12.2%)of other surgical history.(3)Type and diameter of incisional hernia:Thirty-five cases(85.4%)were single incisional hernia,six cases(14.63%)were multiple incisinal hernia.Thirty-eight cases(92.7%)were primary incisional hernia,three cases(7.3%)were recurrent incisional hernia,one had ever placed patch,two did not place patch.The average diameter of hernia ring was 10.3±3.0 cm.The number of different type of incisinal hernia was follows: middle and small incision hernia(n=14,34.1%),large incision hernia(n=15,36.6%),giant incision hernia(n=12,29.3%).(4)Reason of hybrid surgery: Among 41 patients,twenty-five cases(61.0%)underwent hybrid surgery because of close intestinal adhesion that it is hard to separate adhesion under laparoscope,sixteen cases(39.0%)underwent hybrid surgery because of large diameter of hernia ring that can not be closed under laparoscope.(5)Surgical data: All patients were treated with Composix Er X patches produced by Bud Company in the United States: 10.2cm×15.2cm 8 cases(19.5%),12.7cm×17.8cm 6 cases(14.6%),15.2cm×20.3cm 10 cases(24.4%),17.8cm×22.9cm 9 cases(22.0%),20.3cm×25.4cm8 cases(19.5%).The average operative time was 187.6±70.7 minutes.The VAS score of 48 hours after operation was 3.2±0.7.The average postoperative hospital stay was4.5 ±2.6 days,and 33 patients(80.5%)were indwelt drainage.The average drainage time was 14.5±3.2 days.(6)Follow-up date: All patients were followed up.The average followed-up time was 5-69 months(average time 29.2±17.1 months).Six patients suffered from postoperative complication: Postoperative chronic pain 2cases(4.9%),postoperative incomplete intestinal obstruction 2 cases(4.9%),incision infection 2 cases(4.9%).No seroma,patch infection,intestinal fistula,celiac septal syndrome occurred in all patients during the follow-up period,and no recurrence occurred.Conclusion:The treatment of abdominal incisional hernia is focused on the choice of surgical methods.For patients with giant incisional hernia,hybrid technique can reduce the recurrence rate after operation,and for patients with close intestinal adhesion,hybrid technique can reduce the incidence of intestinal fistula.We should choose reasonable surgical method under the patient's condition to benefit the patient.