Totally endoscopic suprabupic approach to ventral hernia repair: Advantages of a new minimally invasive procedure

Severe rectus diastasis with midline hernia associated in males: high recurrence in mid-term follow-up of minimally invasive surgical technique

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.

Endoscopic onlay repair for ventral hernia and rectus abdominis diastasis repair: Why so many different names for the same procedure? A qualitative systematic review

BACKGROUND

A subcutaneous endoscopic onlay repair for ventral hernia with an anterior plication of diastasis recti (DR) has been published under different names in different countries. The aim of this systematic review is to assess the safety and feasibility of different named techniques with the same surgical concept.

METHODS

The PRISMA guidelines were followed during all stages of this systematic review. The MINORS score system was used to perform qualitative assessment of all studies included in this review. Recommendations were then summarized for the following pre-defined key items: protocol, research question, search strategy, study eligibility, data extraction, study designs, risk of bias, publication bias, heterogeneity, and statistical analysis.

RESULTS

The systematic literature search found 2548 articles, 317 of which were duplicates and excluded from analysis. The titles and abstracts from the remaining 2231 articles were assessed. After careful evaluation, 2125 articles were determined to be unrelated to our study and subsequently excluded. The full text of the remaining 106 articles was thoroughly assessed. Case reports, editorials, letters to the editor, and general reviews were then excluded. A total of 13 articles were ultimately included for this review, describing a similar subcutaneous endoscopic approach for repair of concomitant ventral hernias and rectus diastasis defined under nine different named techniques on 716 patients. The number of patients in those studies varied from 10 to 201. The mean operative time varied from 68.5 to 195 min. The most common complication was seroma, followed by pain requiring intervention, hematoma, and surgical site infection.

CONCLUSIONS

There are a few technique variations described in different studies, but with no significant differences in outcomes. We, therefore, propose to unify these procedures under one term, ENDoscopic Onlay Repair (ENDOR). This technique has shown to be effective and safe, with seroma being the most common complication.