P-097 MINIMALLY INVASIVE REPAIR IN SEVERE RECTUS DIASTASIS WITH MIDLINE HERNIA ASSOCIATED IN MALES SHOWS HIGH RECURRENCE IN MID-TERM FOLLOW-UP. CASE-CONTROL STUDY

Aim

Endoscopic plication could develop excessive midline tension that could increase recurrence rate in patients with severe rectus diastasis (SRD). New minimally invasive endoscopic repair (FESSA technique)(FT) was proposed to corrects both pathologies. Aim: assess clinical results, postoperative pain, functional recovery and recurrence of FT compared to endoscopic anterior rectus sheaths plication and mesh (ARSP).

Patients and Methods

male patients with ventral/incisional hernia and SRD were included. 2017–2019 patient underwent to ARSP. 2019–2020 patients underwent to FT. data: Defect and diastasis width and length. Surgical results: Operation time, Intraoperative complications, Hospital stay,Postoperative complications,Pain on 1th/7th/30th days, Functional recovery, Hernia recurrence. Statistic variables were compared using nonparametric tests.

Results

53 patients were included. 28 patients underwent FT and 25 to ARSP. operative time: 70 +/-9 min in FT, 55+/- 7 min in ARSP with significant differences.Hospital stay:1.4+/- 0,5 days for FT and 2,08+/-0,5 for ARSP with significant differences. one postoperative subcutaneous hematoma, requiring surgical removal (2%) in ARSP. Pain at postoperative day 1:21+/2 in FT and 25 +/-2 in ARSP without differences. Pain after 7 and 30 days,significant improvement were shown in favor of FT. functional recovery at 1 month: 17,8 +/-2,4 in FT and 27,8 +/-3,3 in ARSP with significant improvement in FT. recurrence after 24 months: 1 patient in FT (3.6%) and 9 patient in ARSP(36.0%) with significant differences.

Conclusions

Minimally invasive endoscopic Anterior rectus sheaths plication with mesh in SRD and midline hernias, shows higher recurrence rate, postoperative pain and worse functional recovery due to probably excessive midline tension.

Endoscopic retromuscular technique (eTEP) vs conventional laparoscopic ventral or incisional hernia repair with defect closure (IPOM +) for midline hernias. A case-control study

PURPOSE

This study aimed at clinical results in terms of postoperative pain and functional recovery of new technique (eTEP) compared to IPOM + for ventral/incisional midline hernias. Recurrence rate, intra/postoperative complications and aesthetic results are secondary aims.

METHODS

Data from consecutive patients requiring minimally invasive hernia repair were collected. From January 2015 to September 2018, patients with midline ventral/incisional hernias underwent IPOM + were compared to patients underwent eTEP procedure from October 2018 to December 2019 in a case/control study.

RESULTS

Thirty-nine patients in IPOM + group and 40 in eTEP group were included. No significant differences were identified when hernias types, mean defect area, mean mesh area and intraoperative/postoperative complications (except seroma rate in favor of eTEP group) were compared. Operative time and hospital stay were significantly higher in eTEP group and IPOM + group, respectively. eTEP group showed significantly less pain on 1st, 7th and 30th postoperative days than IPOM + group. Restriction of activities was significantly decreased in eTEP group on the 30th and 180th day after surgery. Significant differences were observed in terms of cosmetic results 30th and 180th days after surgery in favor of eTEP group. Average follow-up was 15 months in eTEP group and 28 months in IPOM + group. No recurrences were identified in eTEP group and one recurrence in IPOM + group with no significant differences.

CONCLUSION

Endoscopic retromuscular technique shows significant lower postoperative pain, better functional recovery and cosmesis than IPOM + without differences in intra/postoperative complications (except seroma rate) or recurrences during the follow-up. eTEP requires longer operative time.