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多次手術仍然復發的疝氣如何治療:個案專家討論

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病人在過去二十多年接受過八次左側疝修補手術,包括整型科的皮瓣移植重建,皆再復發,最後兩次是內視鏡疝修補手術,還是失敗, CT 顯示如附圖.

IPOM?TIPP?若用Ti-mesh會較服貼一半在腹膜前一半在腹膜onlay, 但不知好不好分,病人用過三次mesh, 也開過robot!

以上是開過8次左側疝氣手術仍然復發病人的CT 和外覌

光想到前面後面都開過就頭皮發麻!更不用說總共八次手術!!
非常好奇院長怎麼處理?

所以才請各位專家提供髙見,由前面開除疤痕組織及殘留人工網外又怕傷到移植 flap 的血液供應,後面 scope approach 又因已開過三次內鏡手術(包括一次prostate), 腹膜前空間不易展開而且危險.請教黃院長手術發現及如何修補如此困難的病例CT 看起來是較高的地方突出 屬於atypical lateral hernia 好像有兩側hernia?
這個實在太難了!


scope 的話 試著剝離沾黏 用IPOM , SUPRO-PUBIC的方式看看

萬一失敗 就從中線OPEN進去  stoppa repair (maybe IPOM)
真的棘手 
真想上去做紀錄片


蔡理事長及蔡主任的CT reading 太厲害了,右邊也有原發疝氣,左邊因多次復發,屬extrafurnicular (atypical, direct type, ) lateral triangle hernia
這對我們年輕醫生來講,真是太難太複雜了。希望往後有機會聽到顧問寶貴經驗的分享!


明天有新的eTEP,我們趕快把多次復發左側疝氣結案:由於開過八次手術包括最後兩次內视鏡修補及前列腺癌 robot 手術,內視腹膜前空間的分離一定相當困難而且危險,即使用Ipom也需把人工網下端插到恥骨縫合及Cooper勒帶前,游離膀胱及股孔,最後還是採前開式後人工網修補(TIPP)術後三個月沒有復發。

 

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