Application of three-dimensional visualization technique in complex abdominal incisional hernia: an experience of 48 cases_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

PENG Xuefeng ^1,2 , YANG Hua ² , LI Hui ² ,  SONG Yinghan ^3,4 , ZHANG Yuchen ³ , LEI Wenzhang ^1,4

1. Division of Gastrointestinal Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Department of General Surgery, Zigong Fourth People’s Hospital, Zigong, Sichuan 643000, P. R. China;
3. Day Surgery Center, General Practice Medical Center, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
4. Department of Gastrointestinal Surgery, West China Tianfu Hospital, Sichuan University, Chengdu 610213, P. R. China;

Corresponding author：

SONG Yinghan, Email: yinghan2222@163.com

Keywords：

three-dimensional visualization technology; complex abdominal incisional hernia

DOI：

10.7507/1007-9424.202402054

Video：

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Objective To evaluate the application value of three-dimensional visualization (3DV) technique in the reconstruction of complex abdominal incisional hernia. Methods The clinical data of the patients with complex abdominal incisional hernia admitted to the West China Hospital of Sichuan University from September 2021 to September 2022 were collected. The area of abdominal wall defects was analyzed by Medraw software and reconstructed using 3DV technique, then the classifying and partition of abdominal wall defects were performed, the hernia sac/ intraabdominal volume ratio was calculated, patch size was estimated, and intraabdominal pressure values at 24 h and 48 h after surgery as well as operation time, complications were recorded. Results A total of 48 patients with complex abdominal incisional hernia were enrolled, including 30 cases of midline abdominal incisional hernia and 18 cases of other sites. There were 13 cases of moderate hernia, 19 cases of large hernia, and 16 cases of huge hernia. The abdominal wall defect area measured by 3DV technique for the 48 patients was (92.11±60.25) cm², the hernia sac / intraabdominal volume ratio was (7.7±5.2)%, and the actual defect area measured intraoperatively was (89.20±57.38) cm². Pearson correlation analysis showed a positive correlation between the preoperative 3DV measurement and intraoperative measurement (r=0.959, P<0.001). The operation time was (73.5±8.2) min, postoperative anal exhaust time (31.66±15.32) h, intraabdominal pressures at 24 h and 48 h postoperatively were (13.50±2.12) mmHg and (11.39±1.42) mmHg, respectively. The patient’s hospitalization time was (7.12±1.21) d. Among the 48 patients, 7 cases (14.58%) experienced complications after surgery, recovered smoothly after conservative treatment and no unplanned reoperation was required. All patients were followed up for 18–32 months with a median time of 26 months, and no long-term hernia recurrence was observed. Conclusion From the analysis results of this study, it can be seen that the application of 3DV technique to evaluate complex abdominal wall defects can assist hernia surgeons to make a correct choice and has a better safety and effect.

Citation： PENG Xuefeng, YANG Hua, LI Hui, SONG Yinghan, ZHANG Yuchen, LEI Wenzhang. Application of three-dimensional visualization technique in complex abdominal incisional hernia: an experience of 48 cases. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(8): 928-932. doi: 10.7507/1007-9424.202402054 Copy

1.	Song Z, Dong W, Yang D, et al. Application of 3D visualization technology in complex abdominal wall defects. Int J Gen Med, 2021, 14: 2449-2457.
2.	林佳鑫, 刁德昌, 廖伟林, 等. CT三维重建及3D打印技术在复杂的腹膜后肿瘤手术中的应用. 结直肠肛门外科, 2022, 28(2): 119-123.
3.	原珍团, 邓开鸿, 余建群, 等. 腹壁疝的螺旋CT表现及临床应用. 华西医学, 2009, 24(9): 2378-2380.
4.	杨硕, 陈杰. 复杂腹壁疝治疗相关要点. 中国实用外科杂志, 2021, 41(4): 387-391.
5.	黄鹤光, 林荣贵. 腹壁疝的规范化治疗. 中国普外基础与临床杂志, 2018, 25(12): 1413-1415.
6.	刘飞德, 李基业, 姚胜, 等. 腹壁疝补片修补术后感染的外科处理. 中国普外基础与临床杂志, 2011, 18(12): 1292-1295.
7.	中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 腹壁切口疝诊断和治疗指南(2018年版). 中华外科杂志, 2018, 56(7): 499-502.
8.	潘丽杰, 孙丽萍, 马清芸, 等. 间接腹腔压力监测在重症监护中的应用. 青海医药杂志, 2007, 37(4): 55-56.
9.	李雯莉, 曹务腾, 王馨华, 等. 渐进性人工气腹前后基于3D精准容积重建术前“透视”腹壁疝. 影像研究与医学应用, 2019, 3(20): 14-16.
10.	陈杰, 秦昌富, 申英末. 主动减容手术在巨大腹壁疝治疗中的应用和进展. 中华消化外科杂志, 2016, 15(10): 950-953.
11.	李绍杰, 孟云潇, 李绍春, 等. 腹膜腱膜瓣加强补片修补技术用于腹壁切口疝手术158例报告. 中国实用外科杂志, 2021, 41(4): 398-401.
12.	马宁, 汤福鑫, 黄恩民, 等. “对位对线”补片固定法在腹腔镜切口疝修补术中的应用. 中国普通外科杂志, 2022, 31(4): 474-480.
13.	乐飞, 李健文. 微创腹壁切口疝的术式进展、争议和展望. 外科理论与实践, 2020, 25(3): 198-201.
14.	Brophy SA, Minor S, French DG. Abdominal compartment syndrome following paraesophageal and diaphragmatic hernia repair. ACG Case Rep J, 2024, 11(5): e01344. doi: 10.14309/crj.0000000000001344.
15.	Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on intra-abdominal hypertension and abdominal compartment syndrome. Ⅰ. Definitions. Intensive Care Med, 2006, 32(11): 1722-1732.
16.	李基业. 巨大腹壁切口疝的现代外科治疗. 中国普外基础与临床杂志, 2003, 10(1): 10-12.
17.	麦麦提艾力·麦麦提明, 玉素甫, 克力木. 腹腔容积测定在巨大疝治疗及其相关并发症中的意义. 中华普通外科杂志, 2017, 32(7): 634-636.
18.	汤福鑫, 李英儒, 杨伟胜, 等. 术前渐进性气腹在老年腹壁巨大切口疝修补术中的应用价值. 中华疝和腹壁外科杂志(电子版), 2019, 13(2): 105-110.
19.	杜宇, 侯清. 巨大腹壁疝修补术中应用主动减容手术对腹腔内高压及预后的影响. 中华疝和腹壁外科杂志(电子版), 2019, 13(4): 365-368.
20.	李炎铭, 刘军伟, 梁鑫鸿, 等. 立体缝合技术在腹腔镜巨大切口疝修补术中的应用效果研究. 浙江创伤外科, 2023, 28(4): 780-783.
21.	Michael LL, Hego N, Mahmoud M, et al. Enterocutaneous fistula from a mesh eroding the small bowel after incisional hernia repair: a case report. Internation J Abdomin Wall Hernia Surg, 2023, 6(1): 48-52 .

1. Song Z, Dong W, Yang D, et al. Application of 3D visualization technology in complex abdominal wall defects. Int J Gen Med, 2021, 14: 2449-2457.
2. 林佳鑫, 刁德昌, 廖伟林, 等. CT三维重建及3D打印技术在复杂的腹膜后肿瘤手术中的应用. 结直肠肛门外科, 2022, 28(2): 119-123.
3. 原珍团, 邓开鸿, 余建群, 等. 腹壁疝的螺旋CT表现及临床应用. 华西医学, 2009, 24(9): 2378-2380.
4. 杨硕, 陈杰. 复杂腹壁疝治疗相关要点. 中国实用外科杂志, 2021, 41(4): 387-391.
5. 黄鹤光, 林荣贵. 腹壁疝的规范化治疗. 中国普外基础与临床杂志, 2018, 25(12): 1413-1415.
6. 刘飞德, 李基业, 姚胜, 等. 腹壁疝补片修补术后感染的外科处理. 中国普外基础与临床杂志, 2011, 18(12): 1292-1295.
7. 中华医学会外科学分会疝与腹壁外科学组, 中国医师协会外科医师分会疝和腹壁外科医师委员会. 腹壁切口疝诊断和治疗指南(2018年版). 中华外科杂志, 2018, 56(7): 499-502.
8. 潘丽杰, 孙丽萍, 马清芸, 等. 间接腹腔压力监测在重症监护中的应用. 青海医药杂志, 2007, 37(4): 55-56.
9. 李雯莉, 曹务腾, 王馨华, 等. 渐进性人工气腹前后基于3D精准容积重建术前“透视”腹壁疝. 影像研究与医学应用, 2019, 3(20): 14-16.
10. 陈杰, 秦昌富, 申英末. 主动减容手术在巨大腹壁疝治疗中的应用和进展. 中华消化外科杂志, 2016, 15(10): 950-953.
11. 李绍杰, 孟云潇, 李绍春, 等. 腹膜腱膜瓣加强补片修补技术用于腹壁切口疝手术158例报告. 中国实用外科杂志, 2021, 41(4): 398-401.
12. 马宁, 汤福鑫, 黄恩民, 等. “对位对线”补片固定法在腹腔镜切口疝修补术中的应用. 中国普通外科杂志, 2022, 31(4): 474-480.
13. 乐飞, 李健文. 微创腹壁切口疝的术式进展、争议和展望. 外科理论与实践, 2020, 25(3): 198-201.
14. Brophy SA, Minor S, French DG. Abdominal compartment syndrome following paraesophageal and diaphragmatic hernia repair. ACG Case Rep J, 2024, 11(5): e01344. doi: 10.14309/crj.0000000000001344.
15. Malbrain ML, Cheatham ML, Kirkpatrick A, et al. Results from the International Conference of Experts on intra-abdominal hypertension and abdominal compartment syndrome. Ⅰ. Definitions. Intensive Care Med, 2006, 32(11): 1722-1732.
16. 李基业. 巨大腹壁切口疝的现代外科治疗. 中国普外基础与临床杂志, 2003, 10(1): 10-12.
17. 麦麦提艾力·麦麦提明, 玉素甫, 克力木. 腹腔容积测定在巨大疝治疗及其相关并发症中的意义. 中华普通外科杂志, 2017, 32(7): 634-636.
18. 汤福鑫, 李英儒, 杨伟胜, 等. 术前渐进性气腹在老年腹壁巨大切口疝修补术中的应用价值. 中华疝和腹壁外科杂志(电子版), 2019, 13(2): 105-110.
19. 杜宇, 侯清. 巨大腹壁疝修补术中应用主动减容手术对腹腔内高压及预后的影响. 中华疝和腹壁外科杂志(电子版), 2019, 13(4): 365-368.
20. 李炎铭, 刘军伟, 梁鑫鸿, 等. 立体缝合技术在腹腔镜巨大切口疝修补术中的应用效果研究. 浙江创伤外科, 2023, 28(4): 780-783.
21. Michael LL, Hego N, Mahmoud M, et al. Enterocutaneous fistula from a mesh eroding the small bowel after incisional hernia repair: a case report. Internation J Abdomin Wall Hernia Surg, 2023, 6(1): 48-52 .

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application of three-dimensional visualization technique in complex abdominal incisional hernia: an experience of 48 cases

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