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Lucchi A, Romeo L, Ciarrocchi AP, Grassia M, Cacurri A, Agostinelli L, Vitali G, Ripoli MC, Petrarulo F, De Cristofaro C, Cipressi C, Urgo MFL. Laparoscopic retromuscular hernia repair (LaHRR): a case-series of 17 patients treated with a novel technique for laparoscopic ventral hernia and diastasis repair. Surg Endosc 2024:10.1007/s00464-024-11012-5. [PMID: 39014180 DOI: 10.1007/s00464-024-11012-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 06/30/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Many minimally invasive techniques have been developed over the years to treat primary ventral hernias and rectus abdominis diastasis, all of which have their advantages and disadvantages in terms of complications, reproducibility, and cost. We present a case-series of a novel approach that was safe and reproducible in a cohort of 17 patients. PATIENTS AND METHODS All patients in the study underwent the novel procedure between October 2022 and July 2023. We collected data retrospectively, including patient general characteristics, surgical outcomes, and complications. Patient follow-up lasted 12 months to exclude recurrences. RESULTS Seventeen patients underwent the procedure for primary uncomplicated ventral hernias and rectus diastasis. The median length of hospital stay was 2 days (IQR 2-3). In 4 out of 17 cases minor complications occurred within 30 days, of which 3 were class I and 1 was a class II complication according to the Clavien-Dindo classification. There were no recurrences. CONCLUSION Although limited by a small cohort of patients and a non-comparative study design, our study presents encouraging results in regards to the safety of this technique. More studies with a larger study population are needed to evaluate the benefits and pitfalls of this new technique.[query names].
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Affiliation(s)
- Andrea Lucchi
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Luigi Romeo
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Angelo Paolo Ciarrocchi
- Division of Thoracic Surgery, Department of Diagnostic and Specialty Medicine, DIMES of the Alma Mater Studiorum, University of Bologna, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Michele Grassia
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Alban Cacurri
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Laura Agostinelli
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Giulia Vitali
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Maria Cristina Ripoli
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Francesca Petrarulo
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Carlotta De Cristofaro
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Chiara Cipressi
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy
| | - Mariasole Federica Lucia Urgo
- General Surgery Unit of Riccione, Surgical Department of Rimini, AUSL Romagna, Ceccarini Hospital, Viale Frosinone, Riccione, Italy.
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Gómez-Menchero J, Balla A, García Moreno JL, Gila Bohorquez A, Bellido-Luque JA, Morales-Conde S. Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique versus intraperitoneal onlay mesh (IPOM plus) for ventral hernia repair: a comparative analysis. Hernia 2024; 28:167-177. [PMID: 37592164 DOI: 10.1007/s10029-023-02858-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/07/2023] [Indexed: 08/19/2023]
Abstract
PURPOSE Primary aim of this study is to compare the postoperative outcomes of the laparoscopic intracorporeal rectus aponeuroplasty (LIRA) technique to the intraperitoneal onlay mesh closing the defect (IPOM plus), in terms of recurrence and bulging rates at one-year follow-up; secondary aim is to compare the postoperative complications, seroma and pain at 30 days and one-year after surgery. METHODS Patients with midline ventral hernia of 4-10 cm in width were included. Computed tomography scan was performed before, 1 and 12 months after surgery. Pain was evaluated using the visual analogue scale. RESULTS Forty-five and forty-seven consecutive patients underwent LIRA and IPOM plus, respectively. Preoperatively, smoke habits and chronic obstructive pulmonary disease rates were statistically significantly higher in the LIRA group (p = 0.0001 and p = 0.012, respectively). Two bulgings (4.4%) occurred in the LIRA group, while in the IPOM plus group occurred 10 bulgings (21.3%) and three recurrences (6.4%) (p = 0.017 and p = 0.085, respectively). Postoperatively, seven (15.6%, Clavien-Dindo I) and four complications (8.5%, two Clavien-Dindo I, two Clavien-Dindo III-b) occurred in the LIRA and in the IPOM plus group, respectively (p = 0.298). One month after surgery, clinical seroma, occurred in five (11.1%) and eight patients (17%) in the LIRA and in the IPOM plus group, respectively (p = 0.416). During follow-up, pain reduction occurred, without statistically significant differences. CONCLUSIONS In this study, even if we analysed a small series, LIRA showed lower bulging and recurrence rates in comparison to IPOM plus at one-year follow-up. Further prospective studies, with a large sample of patients and longer follow-up are required to draw definitive conclusions.
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Affiliation(s)
- J Gómez-Menchero
- Unit of General and Digestive Surgery, Hospital de Río Tinto, Huelva, Spain
- Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Seville, Spain
| | - A Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Sevilla, Seville, Spain.
- Coloproctology and Inflammatory Bowel Disease Surgery Unit, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132, Milan, Italy.
| | - J L García Moreno
- Unit of General and Digestive Surgery, Hospital de Río Tinto, Huelva, Spain
| | - A Gila Bohorquez
- Unit of General and Digestive Surgery, Hospital de Río Tinto, Huelva, Spain
| | - J A Bellido-Luque
- Department of General Surgery, University Hospital "Virgen Macarena", Seville, Spain
| | - S Morales-Conde
- Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Seville, Spain
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Sevilla, Seville, Spain
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Baur J, Meir M. [Incisional hernias: minimally invasive surgical procedures]. CHIRURGIE (HEIDELBERG, GERMANY) 2024; 95:20-26. [PMID: 38071258 PMCID: PMC10781842 DOI: 10.1007/s00104-023-02000-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/07/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND In recent years many new surgical techniques for minimally invasive treatment of ventral hernias have been developed and introduced. This review article presents these new minimally invasive surgical techniques, such as extended totally extraperitoneal (eTEP) repair, mini or less open sublay (MILOS), endoscopic-assisted linea alba reconstruction (ELAR), the ventral transabdominal preperitoneal patch (TAPP) technique, intraperitoneal onlay mesh (IPOM) plus and laparoscopic intracorporeal rectus aponeuroplasty (LIRA) and discusses recently published results. RESULTS Modern minimally invasive techniques for the treatment of ventral hernias have the potential to reduce surgical site infections, lower postoperative pain and lead to a shorter duration of hospital stay compared to the classical open hernia repair; however, especially techniques with a retromuscular mesh position are technically challenging due to the preparation in a limited space and difficult to perform endoscopic sutures and necessitate detailed knowledge of the anatomy of the abdominal wall. The treatment of larger hernias in particular should therefore only be carried out under the prerequisite of extensive experience and case numbers. CONCLUSION The new endoscopic and endoscopically assisted techniques for treatment of ventral hernias enable the experienced laparoscopic surgeon to primarily and secondarily treat ventral hernias with minimally invasive techniques.
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Affiliation(s)
- Johannes Baur
- Hernienzentrum Clarunis, Universitäres Bauchzentrum Basel, Standort St. Claraspital, Basel, Schweiz
| | - Michael Meir
- Klinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinkum Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Deutschland.
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Parker SG, Blake H, Zhao S, van Dellen J, Mohamed S, Albadry W, Akhtar H, Franczak B, Jakkalasaibaba R, Rothnie A, Thomas R. An established abdominal wall multidisciplinary team improves patient care and aids surgical decision making with complex ventral hernia patients. Ann R Coll Surg Engl 2024; 106:29-35. [PMID: 36927113 PMCID: PMC10757872 DOI: 10.1308/rcsann.2022.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2022] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION Abdominal wall reconstruction (AWR) is an emerging subspecialty within general surgery. The practice of multidisciplinary team (MDT) meetings to aid decision making and improve patient care has been demonstrated, with widespread acceptance. This study presents our initial experience of over 150 cases of complex hernia patients discussed in a newly established MDT setting. METHODS From February 2020 to July 2022 (30-month period), abdominal wall MDTs were held bimonthly. Key stakeholders included upper and lower gastrointestinal surgeons, a gastrointestinal specialist radiologist, a plastic surgeon, a high-risk anaesthetist and two junior doctors integrated into the AWR clinical team. Meetings were held online, where patient history, past medical and surgical history, hernia characteristics and up-to-date computed tomography scans were discussed. RESULTS Some 156 patients were discussed over 18 meetings within the above period. Ninety-five (61%) patients were recommended for surgery, and 61 (39%) patients were recommended for conservative management or referred elsewhere. Seventy-eight (82%) patients were directly waitlisted, whereas seventeen (18%) required preoperative optimisation: three (18%) for smoking cessation, eleven (65%) for weight-loss management and three (18%) for specialist diabetic assessment and management. In total, 92 (59%) patients (including operative and nonoperative management) have been discharged to primary care. DISCUSSION A multidisciplinary forum for complex abdominal wall patients is a safe process that facilitates decision making, promotes education and improves patient care. As the AWR subspecialty evolves, our view is that the "complex hernia MDT" will become commonplace. We present our experience and share advice for others planning to establish an AWR centre.
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Affiliation(s)
- SG Parker
- Croydon Health Services NHS Trust, UK
| | - H Blake
- Croydon Health Services NHS Trust, UK
| | - S Zhao
- Croydon Health Services NHS Trust, UK
| | | | - S Mohamed
- Croydon Health Services NHS Trust, UK
| | - W Albadry
- St George’s University Hospitals NHS Foundation Trust, UK
| | - H Akhtar
- Croydon Health Services NHS Trust, UK
| | | | | | - A Rothnie
- Croydon Health Services NHS Trust, UK
| | - R Thomas
- Croydon Health Services NHS Trust, UK
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Mandujano CC, Lima DL, Xia J, Sreeramoju P, Malcher F. An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis Muscle. JOURNAL OF ABDOMINAL WALL SURGERY : JAWS 2022; 1:10864. [PMID: 38314159 PMCID: PMC10831646 DOI: 10.3389/jaws.2022.10864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 10/31/2022] [Indexed: 02/06/2024]
Abstract
Purpose: We present our algorithmic approach for symptomatic ventral hernias with Diastasis of the Rectus Abdominis Muscle (DRAM). Methods: Retrospective analysis of patients with symptomatic ventral hernias and DRAM undergoing hernia repair and plication of DRAM from July 2018-March 2021 was conducted. Based on our algorithm, patients were selected for an Endoscopic Onlay Repair (ENDOR) or a Robotic Extended Totally Extraperitoneal Ventral Repair (R-eTEP). Results: We performed a R-eTEP in fifty-seven patients and an ENDOR in twenty-four patients. In the R-eTEP group, thirty-seven (65%) patients were female, the mean age was 54.8 (±10.6), and the mean BMI was 32 (±4.8). Fifty patients (87.7%) had multiple defects, of which 19 (38%) were recurrent hernias and 31 (62%) were incisional hernias. The mean operative time was 200 (±62.4) minutes, with two cases requiring a hybrid approach. The median length of stay was 1 day (0-12), and the median follow-up was 103 days. Twenty-four patients underwent an ENDOR, 19 females (79.2%), the mean age was 45.7 years (±11.7) and the mean BMI was 28 (±3.6). 13 patients had isolated umbilical or epigastric hernias. The mean operative time was 146.2 min (±51.1). Fibrin sealant and suture was the predominant method for mesh fixation, and most cases were performed in an ambulatory setting. Four patients developed post-operative seromas; one requiring drainage due to infection. The Median follow-up was 48.5 days (10-523), with two reported hernia recurrences. Conclusion: An algorithmic approach for adequate patient selection was shown to be safe for treating ventral hernias with DRAM.
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Affiliation(s)
| | - Diego L. Lima
- Department of Surgery, Montefiore Medical Center, Bronx, NY, United States
| | - Jason Xia
- Department of Surgery, Montefiore Medical Center, Bronx, NY, United States
| | | | - Flavio Malcher
- Abdominal Wall Reconstruction Program, Department of Surgery, Montefiore Medical Center, Bronx, NY, United States
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Bellido-Luque J, Gomez-Rosado JC, Bellido-Luque A, Matamoros IS, Muñoz AN, Mompeán FO, Conde SM. Severe rectus diastasis with midline hernia associated in males: high recurrence in mid-term follow-up of minimally invasive surgical technique. Hernia 2022; 27:335-345. [PMID: 36454301 DOI: 10.1007/s10029-022-02706-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/01/2022] [Indexed: 12/03/2022]
Abstract
PROPOSE The present study aimed to assess clinical results, in terms of postoperative pain, functional recovery and recurrence rates of FESSA (Full Endoscopic Suprapubic Subcutaneous Access) technique compared to endoscopic anterior rectus sheaths plication and mesh, in male patients with midline ventral or incisional hernias and severe rectus diastasis (SRD) associated. Secondary aims were to identify intra- and postoperative complications associated with each technique. METHODS Male patients with midline ventral or incisional hernia and severe rectus diastasis were included in a prospectively maintained databased and retrospectively analyzed from January 2017 to December 2020. From January 2017 to January 2019, male patients underwent to anterior rectus sheaths plication (ARSP) (Control group). From January 2019 to December 2020, male patients underwent to FESSA technique (FT) (Case group). RESULTS 53 patients were finally included. 28 patients (52%) underwent to FT and 25 patients (48%) to ARSP. Regarding intraoperative complications, no significant differences were identified between the groups. Hospital stay was significantly improved in FT group when compared to ARSP group. No significant differences in terms of postoperative seroma or hematomas, were shown. FT group showed significantly less pain on 1st, 7th and 30th postoperative days than ARSP group. Functional recovery was significantly improved in FT group compared to ARSP group on the 30th day and no differences were observed on the 180th day after surgery. The mean follow-up was 17.3 ± 2.6 months in FT group and 24 ± 3 months in ARSP group. During the follow-up, 1(3%) and 9 (36%) diastasis recurrences were identified respectively, with significant differences in favor of FT group. CONCLUSION In males with SRD and symptomatic midlines hernias, ARSP with onlay mesh placement shows high diastasis recurrence rate in mid-term follow-up. We propose FESSA technique in those patients, which decreases the excessive midline tension, improving the postoperative pain, functional recovery and recurrence rate, without increasing postoperative complications.
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Affiliation(s)
- J Bellido-Luque
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain.
- Gastrointestinal Surgical Department, QuirónSalud Sagrado Corazón Hospital, Seville, Spain.
| | - J C Gomez-Rosado
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - A Bellido-Luque
- Gastrointestinal Surgical Department, QuirónSalud Sagrado Corazón Hospital, Seville, Spain
| | - I Sanchez Matamoros
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - A Nogales Muñoz
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - F Oliva Mompeán
- Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain
| | - S Morales Conde
- Gastrointestinal Surgical Department, QuirónSalud Sagrado Corazón Hospital, Seville, Spain
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Gómez-Menchero J, Balla A, Fernández Carazo A, Morales-Conde S. Primary closure of the midline abdominal wall defect during laparoscopic ventral hernia repair: analysis of risk factors for failure and outcomes at 5 years follow-up. Surg Endosc 2022; 36:9064-9071. [PMID: 35729405 DOI: 10.1007/s00464-022-09374-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The primary aim of this prospective study is to report bulging and recurrence rates and to analyze the risk factors responsible for failure, after laparoscopic ventral hernia repair (LVHR) with primary closure of defect (PCD) using a running suture and intraperitoneal mesh placement, at 5-year follow-up. The secondary endpoint is to evaluate 30-day postoperative complications, seroma, and pain. METHODS PCD failure was defined as the presence of postoperative bulging and/or recurrence. Pain was evaluated using a visual analogue scale (VAS). After surgery, fifty-eight patients underwent clinical examination and computed tomography scan to diagnose bulging, recurrence, and seroma (classified according to the Morales-Conde classification). RESULTS At 60 months follow-up, recurrence was observed in five patients (8.6%), while bulging, not needing a surgical treatment, occurred in fifteen patients (25.9%). Chronic obstructive pulmonary disease (COPD) is the only risk factor responsible for both outcomes together, bulging and recurrences (p = 0.029), while other considered risk factors as gender, age, body mass index, diabetes, smoke habits, primary or incisional hernia and the ratio defect width/transverse abdominal axis did not achieve the statistically significance. Clinical seroma was diagnosed at one month in eight patients (13.8%). Seromas were observed at one year of follow-up. During the follow-up, pain reduction occurred. CONCLUSION LVHR has evolved toward more anatomical concepts, with the current trend being the abdominal wall anatomical reconstruction to improve its functionality, reducing seroma rates. Based on results obtained, PCD is a reliable technique with excellent recurrence rate at 5 years follow-up, even when the defect closure may generate tension at the midline. On the other hand, this tension could be related with high bulging rate at long-term, particular in case of patients with COPD.
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Affiliation(s)
- Julio Gómez-Menchero
- Unit of General and Digestive Surgery, Hospital de Río Tinto, Huelva, Spain
- Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Seville, Spain
| | - Andrea Balla
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Sevilla, Seville, Spain.
| | - Ana Fernández Carazo
- Department of Economics, Quantitative Methods and Economic History, Pablo de Olavide University, Seville, Spain
| | - Salvador Morales-Conde
- Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Seville, Spain
- Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio", University of Sevilla, Seville, Spain
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Gómez-Valles P, Jeri-McFarlane S, Gomez-Menchero J, Morales-Conde S. Moving the concept associated to laparoscopic intracorporeal rectus aponeuroplasty (LIRA) to lateral hernia. Cir Esp 2022; 100:780-782. [PMID: 36428009 DOI: 10.1016/j.cireng.2022.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 03/27/2022] [Indexed: 06/16/2023]
Abstract
The surgical repair of lateral hernias is considered a challenge. Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) has been described as a minimally invasive technique for primary incisional ventral hernias of the midline, especially for M2 to M4 ventral hernias but the indications of the concept associated to LIRA are beginning to expand to other complex locations. The aim of this video is to show the surgical steps for lateral hernias where the concept associated to LIRA is followed to repair this type of hernias.
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Affiliation(s)
- Paula Gómez-Valles
- Department of General & Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Seville, Spain; Department of General & Digestive Surgery, Hospital Clínico Virgen de la Arrixaca, Murcia, Spain.
| | - Sebastián Jeri-McFarlane
- Department of General & Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Seville, Spain; Department of General & Digestive Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Julio Gomez-Menchero
- Department General & Digestive Surgery, Hospital General Básico de Riotinto, Huelva, Spain
| | - Salvador Morales-Conde
- Department of General & Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Seville, Spain; Unit of Innovation in Minimally Invasive Surgery, Department of General & Digestive Surgery, University Hospital Virgen del Rocío, University of Sevilla, Seville, Spain
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Jeri-McFarlane S, Gómez-Valles P, Gomez-Menchero J, Sánchez-Ramírez M, Morales-Conde S. Expanding indication of laparoscopic intracorporeal rectus aponeuroplasty (LIRA) to suprapubic area: LIRA & TAPE. Cir Esp 2022; 100:641-643. [PMID: 36109116 DOI: 10.1016/j.cireng.2022.08.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/03/2022] [Indexed: 06/15/2023]
Abstract
Laparoscopic intracorporeal rectus aponeuroplasty (LIRA) is a minimally invasive technique described to repair M2-M4 primary and incisional hernias. Defects below this area (M5 - Suprapubic area) could be treated using the concept associated to LIRA, expanding the indication of this technique in combination with a transabdominal partially extraperitoneal (TAPE) repair. The aim of this video is to show the surgical steps in the combination of LIRA & TAPE for M2-M5 ventral hernias.
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Affiliation(s)
- Sebastián Jeri-McFarlane
- Department of General & Digestive Surgery, Hospital Universitario Son Espases, Palma de Mallorca, Spain.
| | - Paula Gómez-Valles
- Department of General & Digestive Surgery, Hospital Clínico Virgen de la Arrixaca, Murcia, Spain
| | - Julio Gomez-Menchero
- Department General & Digestive Surgery, Hospital General Básico de Riotinto, Huelva, Spain
| | - María Sánchez-Ramírez
- Department General & Digestive Surgery, Hospital Universitario Juan Ramón Jimenez, Huelva, Spain
| | - Salvador Morales-Conde
- Unit of Innovation in Minimally Invasive Surgery, Upper IG & Bariatric Surgery, Department of General & Digestive Surgery, University Hospital Virgen del Rocío, Seville, Spain
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Lima DL, Salas-Parra R, C L Lima RN, Sreeramoju P, Camacho D, Malcher F. Robotic Intracorporeal Rectus Aponeuroplasty: Early Experience of a New Surgical Technique for Ventral Hernia Repair. J Laparoendosc Adv Surg Tech A 2022; 32:1092-1096. [PMID: 36036807 DOI: 10.1089/lap.2022.0303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: The laparoscopic intracorporeal rectus aponeuroplasty (LIRA) was developed as an alternative for minimally invasive ventral hernia repair. This technique allows the closure of the defect and restoration of the midline without tension by plication of both aponeurosis of the abdominal rectus muscles combined with a minimally invasive intraperitoneal underlay mesh repair. The objective of this study is to report our early experience with the Robotic-LIRA (R-LIRA) technique and its safety and short-term efficacy. Methods: We performed a retrospective analysis of patients undergoing R-LIRA repair for ventral hernias from March 2019 to April 2022. Results: Eight patients underwent R-LIRA from March 2019 to April 2022. Median age was 47 years (interquartile range [IQR] 34.5-62.8). Median body mass index was 34.2 kg/m2 (IQR 29.9-35.2). Four patients (50%) had a primary ventral hernia being one M2, two M3, and one M2/M3. There were three incisional hernias, being one recurrent, 6 patients (75%) had associated diastasis of the rectus muscle and 1 patient presented pure diastasis. The median hernia width was 4 cm (IQR 2-6), and the median defect area was 16 cm2 (IQR 4-42). The median mesh area was 290 cm2 (IQR 211.2-300). In all cases, a barbed suture was also used for mesh fixation, and tackers were added in 4 cases. The median operative time was 172 minutes (IQR 139.8-293.3). The median length of stay was 0.5 days (IQR 0-1.8), and the median follow-up was 20 days (IQR 16-46). Conclusion: The R-LIRA has been shown to be safe and feasible for ventral and incisional hernia repairs with or without Diastasis of the Rectus Abdominis Muscle in the short term.
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Affiliation(s)
- Diego L Lima
- Department of Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Ruben Salas-Parra
- Department of Surgery, Bronxcare Healthcare System, Bronx, New York, USA
| | | | | | - Diego Camacho
- Department of Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Flavio Malcher
- Department of Surgery, NYU Langone, New York, New York, USA
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Moving the concept associated to laparoscopic intracorporeal rectus aponeuroplasty (LIRA) to lateral hernia. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Taşdelen HA. The extended-view totally extraperitoneal (eTEP) approach for incisional abdominal wall hernias: results from a single center. Surg Endosc 2022; 36:4614-4623. [PMID: 35059841 DOI: 10.1007/s00464-021-08995-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/31/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The extended-view totally extraperitoneal (eTEP) approach is a promising technique for abdominal wall hernias and has increased in popularity among hernia surgeons in recent years. This study aims to present the results of applying the laparoscopic eTEP approach for incisional abdominal wall hernias (IAWHs). METHODS This study is a retrospective analysis of a prospectively collected dataset of 30 patients who underwent laparoscopic eTEP for IAWHs between October 2018 and March 2021 (median follow-up of 15 months). RESULTS Thirty patients (8 male, 22 female) with a mean age, mean body mass index, and median ASA score of 53.5, 30.8, and 2, respectively, underwent the eTEP procedure for incisional abdominal wall hernias. In total, 11 (36.7%) patients had a recurrent IAWH. Seventeen (56.7%) patients were treated with eTEP RivesStoppa (eTEP-RS), whereas 10 (33.3%) patients needed the eTEP transversus abdominis release (eTEP-TAR) procedure. In three patients, conversions to other procedures (laparoscopic intraperitoneal onlay mesh-plus (IPOM-Plus) and open RivesStoppa) were needed due to intraoperative complications: iatrogenic perforation to the intestine and large peritoneal tear causing loss of the working space. The mean operative time and mean length of stay (LOS) were 203.5 min and 1.5 days for eTEP-RS and 291.5 min and 1.6 days for eTEP-TAR, respectively. Two patients developed asymptomatic seromas, and one patient developed an asymptomatic hematoma; all were treated conservatively. Only one recurrence was observed over the course of the follow-up period. CONCLUSIONS The eTEP approach is a safe and feasible option for IAWH repair and a valuable addition to the armamentarium of hernia surgeons.
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Affiliation(s)
- Halil Afşin Taşdelen
- Department of General Surgery, Trabzon Kanuni Training and Research Hospital, Kasustu Mah. Topal Osman Cad. No: 7, Yomra, 61040, Trabzon, Turkey.
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Open Versus Laparoscopic Surgical Management of Rectus Diastasis: Systematic Review and Pooled Analysis of Complications and Recurrence Rates. World J Surg 2022; 46:1878-1885. [DOI: 10.1007/s00268-022-06550-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
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14
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Expanding indication of laparoscopic intracorporeal rectus aponeuroplasty (LIRA) to suprapubic area: LIRA & TAPE. Cir Esp 2022. [DOI: 10.1016/j.ciresp.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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15
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Baur J, Ramser M, Keller N, Muysoms F, Dörfer J, Wiegering A, Eisner L, Dietz UA. Robotic hernia repair II. English version : Robotic primary ventral and incisional hernia repair (rv‑TAPP and r‑Rives or r‑TARUP). Video report and results of a series of 118 patients. Chirurg 2021; 92:15-26. [PMID: 34374823 PMCID: PMC8695563 DOI: 10.1007/s00104-021-01479-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 11/26/2022]
Abstract
Endoscopic management of umbilical and incisional hernias has adapted to the limitations of conventional laparoscopic instruments over the past 30 years. This includes the development of meshes for intraperitoneal placement (intraperitoneal onlay mesh, IPOM), with antiadhesive coatings; however, adhesions do occur in a significant proportion of these patients. Minimally invasive procedures result in fewer perioperative complications, but with a slightly higher recurrence rate. With the ergonomic resources of robotics, which offers angled instruments, it is now possible to implant meshes in a minimally invasively manner in different abdominal wall layers while achieving morphologic and functional reconstruction of the abdominal wall. This video article presents the treatment of ventral and incisional hernias with mesh implantation into the preperitoneal space (robot-assisted transabdominal preperitoneal ventral hernia repair, r‑ventral TAPP) as well as into the retrorectus space (r-Rives and robotic transabdominal retromuscular umbilical prosthetic repair, r‑TARUP, respectively). The results of a cohort study of 118 consecutive patients are presented and discussed with regard to the added value of the robotic technique in extraperitoneal mesh implantation and in the training of residents.
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Affiliation(s)
- Johannes Baur
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstraße 150, 4600, Olten, Switzerland
| | - Michaela Ramser
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstraße 150, 4600, Olten, Switzerland
| | - Nicola Keller
- Department of General, Visceral and Vascular Surgery, Cantonal Hospital Baden, Im Engel 1, 5404, Baden, Switzerland
| | - Filip Muysoms
- Department of Surgery, AZ Maria Middelares, Buitenring Sint-Denijs 30, 9000, Ghent, Belgium
| | - Jörg Dörfer
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany
| | - Armin Wiegering
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Str. 6, 97080, Wuerzburg, Germany.
| | - Lukas Eisner
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstraße 150, 4600, Olten, Switzerland
| | - Ulrich A Dietz
- Department of Visceral, Vascular and Thoracic Surgery, Cantonal Hospital Olten (soH), Baslerstraße 150, 4600, Olten, Switzerland.
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Baur J, Ramser M, Keller N, Muysoms F, Dörfer J, Wiegering A, Eisner L, Dietz UA. [Robotic hernia repair : Part II: Robotic primary ventral and incisional hernia repair (rv-TAPP and r-Rives or r-TARUP). Video report and results of a series of 118 patients]. Chirurg 2021; 92:809-821. [PMID: 34255114 PMCID: PMC8384833 DOI: 10.1007/s00104-021-01450-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 02/01/2023]
Abstract
Endoscopic management of umbilical and incisional hernias has adapted to the limitations of conventional laparoscopic instruments over the past 30 years. This includes the development of meshes for intraperitoneal placement (intraperitoneal onlay mesh, IPOM), with antiadhesive coatings; however, adhesions do occur in a significant proportion of these patients. Minimally invasive procedures result in fewer perioperative complications, but with a slightly higher recurrence rate. With the ergonomic resources of robotics, which offers angled instruments, it is now possible to implant meshes in a minimally invasively manner in different abdominal wall layers while achieving morphologic and functional reconstruction of the abdominal wall. This video article presents the treatment of ventral and incisional hernias with mesh implantation into the preperitoneal space (robot-assisted transabdominal preperitoneal ventral hernia repair, r‑ventral TAPP) as well as into the retrorectus space (r-Rives and robotic transabdominal retromuscular umbilical prosthetic repair, r‑TARUP, respectively). The results of a cohort study of 118 consecutive patients are presented and discussed with regard to the added value of the robotic technique in extraperitoneal mesh implantation and in the training of residents.
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Affiliation(s)
- Johannes Baur
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Michaela Ramser
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Nicola Keller
- Klinik für Allgemein‑, Viszeral- und Gefässchirurgie, Kantonsspital Baden, Im Engel 1, 5404, Baden, Schweiz
| | - Filip Muysoms
- Department of Surgery, AZ Maria Middelares, Buitenring Sint-Denijs 30, 9000, Gent, Belgien
| | - Jörg Dörfer
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland
| | - Armin Wiegering
- Klinik und Poliklinik für Allgemein‑, Viszeral‑, Transplantations‑, Gefäß- und Kinderchirurgie, Universitätsklinikum Würzburg, Oberdürrbacher Straße 6, 97080, Würzburg, Deutschland.
| | - Lukas Eisner
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz
| | - Ulrich A Dietz
- Klinik für Viszeral‑, Gefäss- und Thoraxchirurgie, Kantonsspital Olten, Baslerstrasse 150, 4600, Olten, Schweiz.
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ElHawary H, Barone N, Zammit D, Janis JE. Closing the gap: evidence-based surgical treatment of rectus diastasis associated with abdominal wall hernias. Hernia 2021; 25:827-853. [PMID: 34319467 DOI: 10.1007/s10029-021-02460-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Rectus diastasis (RD) associated with abdominal hernias present a surgical challenge associated with a paucity in treatment guidelines. The objective of this systematic review is to review surgical techniques and assess complication and recurrence rates of RD in patients with concurrent abdominal hernias. METHODS PubMed and EMBASE databases were systematically searched, and data extraction was performed on articles which met the inclusion criteria. Pooled analyses of complication and recurrence rates were performed to compare open vs. minimally invasive surgery. Student t tests were performed to compare differences in continuous outcomes. RESULTS Twenty-eight studies were included in this review. RD can be surgically repaired by both open and laparoscopic approaches using both non-absorbable and absorbable sutures. The majority of the techniques reported included mesh insertion either above the aponeurosis, retromuscular, preperitoneal, or intraperitoneal. Open techniques, compared to laparoscopic approaches, were associated with a significantly higher rate of skin dehiscence (6.79% vs. 2.86%; p = 0.003) and hematoma formation (4.73% vs. 1.09%; p < 0.001) and a significantly lower rate of post-operative seroma formation (2.47% vs. 8.29%; p < 0.001). No significant difference in RD recurrence rates were observed between open and laparoscopic repair (0.22 vs. 0.63%, p = 0.17). CONCLUSION Both open and laparoscopic surgery are safe and effective methods that can be used to repair RD in patients with RD and concurrent abdominal hernias as evident by the low recurrence and complication rates and almost negligible major complications post repair.
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Affiliation(s)
- H ElHawary
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - N Barone
- Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - D Zammit
- Division of Plastic and Reconstructive Surgery, McGill University Health Centre, Montreal, QC, Canada
| | - J E Janis
- Department of Plastic and Reconstructive Surgery, Ohio State University Wexner Medical Center, 915 Olentangy River Road, Suite 2100, Columbus, OH, 43212, USA.
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Köckerling F, Lorenz R, Stechemesser B, Conze J, Kuthe A, Reinpold W, Niebuhr H, Lammers B, Zarras K, Fortelny R, Mayer F, Hoffmann H, Kukleta JF, Weyhe D. Comparison of outcomes in rectus abdominis diastasis repair-which data do we need in a hernia registry? Hernia 2021; 25:891-903. [PMID: 34319466 DOI: 10.1007/s10029-021-02466-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Rectus abdominis diastasis (RAD) ± concomitant hernia is a complex hernia entity of growing significance in everyday clinical practice. Due to a multitude of described surgical techniques, a so far missing universally accepted classification and hardly existing comparative studies, there are no clear recommendations in guidelines. Therefore, "RAD ± concomitant hernia" will be documented as a separate hernia entity in the Herniamed Registry in the future. For this purpose, an appropriate case report form will be developed on the basis of the existing literature. METHODS A systematic search of the available literature was performed in March 2021 using Medline, PubMed, Google Scholar, Scopus, Embase, Springer Link, and the Cochrane Library. 93 publications were identified as relevant for this topic. RESULTS In total 45 different surgical techniques for the repair of RAD ± concomitant hernia were identified in the surgical literature. RAD ± concomitant hernia is predominantly repaired by plastic but also by general surgeons. Classification of RAD ± concomitant hernia is based on a proposal of the German Hernia Society and the International Endohernia Society. Surgical techniques are summarized as groups subject to certain aspects: Techniques with abdominoplasty, open techniques, mini-less-open and endoscopic sublay techniques, mini-less-open and endoscopic subcutaneous/preaponeurotic techniques and laparoscopic techniques. Additional data impacting the outcome are also recorded as is the case for other hernia entities. Despite the complexity of this topic, documentation of RAD ± concomitant hernia has not proved to be any more cumbersome than for any of the other hernia entities when using this classification. CONCLUSION Using the case report form described here, the complex hernia entity RAD ± concomitant hernia can be recorded in a registry for proper analysis of comparative treatment options.
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Affiliation(s)
- F Köckerling
- Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.
| | - R Lorenz
- Hernia Center 3+CHIRURGEN, Klosterstrasse 34/35, 13581, Berlin, Germany
| | - B Stechemesser
- Pan Hospital, Hernia Center, Zeppelinstraße 1, 50667, Köln, Germany
| | - J Conze
- UM Hernia Center, Arabellastr. 17, 81925, München, Germany
| | - A Kuthe
- DRK-Krankenhaus Clementinenhaus, Lützerodestr. 1, 30161, Hannover, Germany
| | - W Reinpold
- Hernia Center Hamburg, Helios Mariahilf Klinik, Stader Str. 203C, 21075, Hamburg, Germany
| | - H Niebuhr
- Hanse Hernia Center, Alte Holstenstr. 16, 21031, Hamburg, Germany
| | - B Lammers
- Department of Surgery I-Section Coloproctology and Hernia Surgery, Lukas Hospital, Preussenstr. 84, 41464, Neuss, Germany
| | - K Zarras
- Marien Hospital Düsseldorf, Rochusstraße 2, 40479, Düsseldorf, Germany
| | - R Fortelny
- Medical Faculty Austria, Private Hospital Confraternitaet, Sigmund Freud Private University Vienna, 1080, Vienna, Austria
| | - F Mayer
- Department of General, Visceral and Thoracic Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
| | - H Hoffmann
- ZweiChirurgen GmbH-Center for Hernia Surgery and Proctology, St. Johanns-Vorstadt 44, 4056, Basel, Switzerland
- University of Basel, Petersplatz 1, 4001, Basel, Switzerland
| | - J F Kukleta
- Klinik Im Park Zurich (Hirslanden Group), Grossmuensterplatz 9, 8001, Zurich, Switzerland
| | - D Weyhe
- Department of General and Visceral Surgery, Pius Hospital, University Hospital of Visceral Surgery, Georgstrasse 12, 26121, Oldenburg, Germany
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Kozan R, Anadol AZ, Sare M. A new criterion to predict recurrence after laparoscopic ventral hernia repair: mesh/defect area ratio. POLISH JOURNAL OF SURGERY 2021; 93:40-46. [DOI: 10.5604/01.3001.0015.0237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b>Minimizing recurrence in hernia surgery is one of the major aims. Defining surgeon-dependent risk factors for recurrence is therefore of great importance in laparoscopic ventral hernia repair (LVHR). This study aims to analyze the predictive value of the mesh area/defect area ratio (M/D ratio) in terms of recurrence as a new criterion in LVHR.</br> </br> <b>Methods:</b> A total of 124 patients were enrolled in the study. Age, gender, hernia type, body mass index, defect size, size of the mesh, mesh overlapping, area of the defect, area of the mesh, M/D ratio, postoperative complications, follow-up time, recurrences and timing of recurrence were also recorded. The potential variables that may affect recurrence were examined by univariate and multivariate analysis.</br> </br> <b>Results:</b> There were 12 (9.7%) recurrences in our series. A statistically significant difference was found if either the mesh/defect ratio was ≤6 or >6 (p = 0.012). Multivariate analysis confirmed that M/D ratio was the only independent parameter for recurrence. </br></br><b>Conclusion:</b> Understanding M/D ratio concept and using it in surgical clinical practice may help reduce recurrence rates after LVHR.</br>
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Affiliation(s)
- Ramazan Kozan
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Ahmet Ziya Anadol
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Mustafa Sare
- Department of General Surgery, Faculty of Medicine, Gazi University, Ankara, Turkey
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A Comprehensive, Evidence-Based Literature Review of the Surgical Treatment of Rectus Diastasis. Plast Reconstr Surg 2020; 146:1151-1164. [PMID: 33136963 DOI: 10.1097/prs.0000000000007252] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Rectus diastasis is a common condition that can result in a protruding abdomen, causing cosmetic and functional disability. Although it is usually repaired during abdominoplasty or herniorrhaphy, there is a lack of consensus with regard to the repair indications and optimal surgical techniques. The goal of this study is to provide an updated review of the surgical techniques used for rectus diastasis repair and their comparative efficacy. METHODS In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Cochrane databases were searched for articles that discussed the surgical management of rectus diastasis and reported on either outcomes, complications, or recurrence rates. Data detailing surgical techniques were extracted, and pooled analyses of complication and recurrence rates were performed, controlling for surgical approach, common variations in technique, and an associated herniorrhaphy. RESULTS Thirty-seven studies describing 45 techniques were included. An open rectus diastasis repair was performed in 24 of the studies. After controlling for an associated herniorrhaphy, there was no statistically significant difference in surgical complication and recurrence rates between open and laparoscopic approaches (p = 0.165 and p = 0.133, respectively). Although a double-layer suture closure was associated with a significantly lower rate of complications (p = 0.002), no significant difference was found for suture type absorbability. CONCLUSIONS Surgical repair of rectus diastasis is safe and effective through both open and laparoscopic approaches. Although suture type absorbability does not affect complication or recurrence rates, a double-layer suture closure can decrease surgical complications. The pooled analysis of complication and recurrence rates can help improve informed consent and patient education.
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Sukhinin AA, Petrovsky AN. [Minimally invasive correction of anatomical features of anterior abdominal wall and ventral hernias]. Khirurgiia (Mosk) 2020:88-94. [PMID: 33047591 DOI: 10.17116/hirurgia202010188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Conventional «open» procedures for ventral hernias and diastasis recti are widely known, used everywhere and have a great number of author's improvements related to surgeon's experience, availability of modern information, equipment and materials. K. LeBlanc and W. Booth (1993) reported IPOM-method with non-adhesive coating that is considered a milestone in surgery of anterior abdominal wall and ventral hernia. This technique has gained recognition among surgeons around the world due to its technical simplicity, minimal invasiveness and high reproducibility. However, certain disadvantages of this technique have been shown over the past time that justified advisability of searching for another methods of anterior abdominal wall reinforcement. Thus, E-Milos, LIRA, TESAR, eTEP, REPA, TARM, TARUP techniques are currently available. This review is devoted to technical features of these techniques, their potential advantages and disadvantages.
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Affiliation(s)
- A A Sukhinin
- Kuban State Medical University, Krasnodar, Russia
| | - A N Petrovsky
- Research Institute - Ochapovsky Regional Clinical Hospital No. 1, Krasnodar, Russia
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Minimally Invasive Surgery of the Abdominal Wall and Clinically Meaningful Benefit. What Are We Talking About? Cir Esp 2020; 99:171-173. [PMID: 32063298 DOI: 10.1016/j.ciresp.2020.01.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 01/21/2020] [Indexed: 11/21/2022]
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Jessen ML, Öberg S, Rosenberg J. Treatment Options for Abdominal Rectus Diastasis. Front Surg 2019; 6:65. [PMID: 31803753 PMCID: PMC6877697 DOI: 10.3389/fsurg.2019.00065] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/04/2019] [Indexed: 01/24/2023] Open
Abstract
Background: Abdominal rectus diastasis is a condition where the abdominal muscles are separated by an abnormal distance due to widening of the linea alba causing the abdominal content to bulge. It is commonly acquired in pregnancies and with larger weight gains. Even though many patients suffer from the condition, treatment options are poorly investigated including the effect of physiotherapy and surgical treatment. The symptoms include pain and discomfort in the abdomen, musculoskeletal and urogynecological problems in addition to negative body image and impaired quality of life. The purpose of this review was to give an overview of treatment options for abdominal rectus diastasis. Results: The first treatment step is physiotherapy. However, evidence is lacking on which regimen to use and success rates are not stated. The next step is surgery, either open or laparoscopic, and both surgical approaches have high success rates. The surgical approach includes different plication techniques. The recurrence and complication rates are low, complications are minor, and repair improves low back pain, urinary incontinence, and quality of life. Robotic assisted surgery might become a possibility in the near future, but data are still lacking. Conclusions: Evidence on what conservatory treatment to use is sparse, and more research needs to be done. Both open and laparoscopic surgery have shown positive results. Innovative treatment by robotic assisted laparoscopic surgery has potential, however, more research needs to be done in this area as well. An international guideline for the treatment of rectus diastasis could be beneficial for patients and clinicians.
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Affiliation(s)
- Majken Lyhne Jessen
- Department of Surgery, Center for Perioperative Optimization, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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[New laparoendoscopic and minimally invasive extraperitoneal mesh augmentation techniques for ventral hernia repair]. Chirurg 2019; 90:838-844. [PMID: 30911793 DOI: 10.1007/s00104-019-0947-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In recent years techniques for ventral hernia repair have undergone a dynamic evolution with the development of minimally invasive and laparoendoscopic techniques. Despite the multitude of methods, five main criteria for setting the target have emerged: 1) functional and morphological reconstruction of the abdominal wall, 2) extraperitoneal mesh augmentation, 3) abandonment of penetrating fixation elements, 4) minimal surgical access trauma of the abdominal wall and 5) minimized intraperitoneal dissection that jeopardizes adherent intestinal structures. The mesh position varies between preperitoneal retromuscular and supraneurotic or preaponeurotic on the anterior rectus sheath. The different approaches can be carried out transhernially or distant from the abdominal wall defect. The latter can be realized by laparoscopic transperitoneal, endoscopic subcutaneous and endoscopic retromuscular/preperitoneal approaches. Some techniques can be extended to anterior or posterior component separation to reduce tension and to enlarge the space for mesh placement. Robot-assisted surgery opens up new perspectives in laparoendoscopic abdominal wall surgery due to additional instrumental degrees of movement. This enables the possibility of preperitoneal ventral hernia operations also behind and lateral to the posterior rectus muscle compartments as was only previously known below the arcuate line from inguinal hernia surgery.
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Reinpold W, Köckerling F, Bittner R, Conze J, Fortelny R, Koch A, Kukleta J, Kuthe A, Lorenz R, Stechemesser B. Classification of Rectus Diastasis-A Proposal by the German Hernia Society (DHG) and the International Endohernia Society (IEHS). Front Surg 2019; 6:1. [PMID: 30746364 PMCID: PMC6360174 DOI: 10.3389/fsurg.2019.00001] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 01/09/2019] [Indexed: 12/05/2022] Open
Abstract
Introduction: Recently, the promising results of new procedures for the treatment of rectus diastasis with concomitant hernias using extraperitoneal mesh placement and anatomical restoration of the linea alba were published. To date, there is no recognized classification of rectus diastasis (RD) with concomitant hernias. This is urgently needed for comparative assessment of new surgical techniques. A working group of the German Hernia Society (DHG) and the International Endohernia Society (IEHS) set itself the task of devising such a classification. Materials and Methods: A systematic search of the available literature was performed up to October 2018 using Medline, PubMed, Scopus, Embase, Springer Link, and the Cochrane Library. A meeting of the working group was held in May 2018 in Hamburg. For the present analysis 30 publications were identified as relevant. Results: In addition to the usual patient- and technique-related influencing factors on the outcome of hernia surgery, a typical means of rectus diastasis classification and diagnosis should be devised. Here the length of the rectus diastasis should be classified in terms of the respective subxiphoidal, epigastric, umbilical, infraumbilical, and suprapubic sectors affected as well as by the width in centimeters, whereby W1 < 3 cm, W2 = 3− ≤ 5 cm, and W3 > 5 cm. Furthermore, gender, the concomitant hernias, previous abdominal surgery, number of pregnancies and multiple births, spontaneous birth or caesarian section, skin condition, diagnostic procedures and preoperative pain rate and localization of pain should be recorded. Conclusion: Such a unique classification is needed for assessment of the treatment results in patients with RD.
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Affiliation(s)
| | - Ferdinand Köckerling
- Department of Surgery, Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Berlin, Germany
| | | | | | - René Fortelny
- Department of General Surgery, Medical Faculty, Wilhelminen Hospital, Sigmund Freud University, Vienna, Austria
| | | | - Jan Kukleta
- Visceral Surgery Zurich, Hirslanden Klinik Im Park, Zurich, Switzerland
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