Background:Diastasis of the rectus abdominis muscles (DMRA) is frequent and may be associated with abdominal wall hernias. For patients with redudant skin, dermolipectomy and plication of the diastasis is the most commonly used procedure. However, there is a significant group of patients who do not require skin resection or do not want large incisions. Aim:To describe a “new” technique (subcutaneous onlay laparoscopic approach - SCOLA) for the correction of ventral hernias combined with the DMRA plication and to report the initial results of a case series. Method:SCOLA was applied in 48 patients to correct ventral hernia concomitant to plication of DMRA by pre-aponeurotic endoscopic technique. Results:The mean operative time was 93.5 min. There were no intra-operative complications and no conversion. Seroma was the most frequent complication (n=13, 27%). Only one (2%) had surgical wound infection. After a median follow-up of eight months (2-19), only one (2%) patient presented recurrence of DMRA and one (2%) subcutaneous tissue retraction/fibrosis. Forty-five (93.7%) patients reported being satisfied with outcome. Conclusion:The SCOLA technique is a safe, reproducible and effective alternative for patients with abdominal wall hernia associated with DMRA.

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BACKGROUND: Malignant transformation of endometriosis in the abdominal wall is a rare and still poorly understood event. Less than 30 cases have been reported in the worldwide literature. Most cases of solid tumors are report in a previous abdominal scar with malignant transformation of a focus of endometriosis. Presence of lymph node metastases in nearby chains is frequent and is associated with poor prognosis. CASE REPORT: We report a case of a 42-year-old woman with a history of abdominal surgery (Pfannenstiel) to resect abdominal wall endometriosis. Physical examination revealed a solid mass of approximately 10 cm x 6 cm in the anterior wall of the abdomen. Computed tomography (CT) of the abdomen and pelvis showed a heterogeneous, predominantly hypoattenuating expansive formation measuring 10.6 cm x 4.7 cm x 8.3 cm. The patient underwent exploratory incisional laparotomy, block resection of the abdominal mass and lymphadenectomy of the external and inguinal iliac chains. The abdominal wall was reconstructed using a semi-absorbable tissue-separating screen to reconstitute the defect caused by resection of the tumor. Histological evaluation revealed infiltration by malignant epithelioid neoplasia, thus confirming the immunohistochemical profile of adenocarcinoma with clear cell components. Lymphadenectomy showed metastatic involvement of an external iliac chain lymph node. CONCLUSION: Resection of the mass along with the abdominal wall, with wall margins, is the most effective treatment. Reconstruction is a challenge for surgeons. The patient has been followed up postoperatively for eight months, without any evidence of disease to date. I MD. Resident Physician,

RESUMO -Racional -Os defeitos da linha média podem ser congênitos ou adquiridos.Os procedimentos convencionais para correção desse defeito geralmente envolvem grandes incisões, com grandes descolamentos de pele e tecido celular subcutâneo. O uso da videocirurgia para a correção desses defeitos, ainda é controverso. Objetivos -Realizar descrição inédita na literatura, mostrando a experiência inicial do uso da robótica nas reconstruções de linha média, associando a cirurgia minimamente invasiva à técnicas consagradas como Rives/Stoppa e separação de componentes. Métodos -Foram operados cinco pacientes no mesmo hospital, pela mesma equipe, usando o sistema robótico da Vinci S. Resultados -Foram três mulheres e dois homens, sem mortalidade na amostra. Duas pacientes foram reoperadas com hérnia pelo tunel entre os músculos retos do abdomen e aponeurose posterior, com fechamento dos mesmos na reoperação. Conclusões -O procedimento robótico para reconstrução da linha média mostrou-se factível e esteticamente aceitável. Tem a vantagem de seguir os princípios tradicionais aventados para a parede abdominal através de via minimamente invasiva. ABCDDV/857ABSTRACT-Background -The weakness of the linea alba can be caused by congenital and aquired factors. The conventional procedure to correct these imperfections generally involve large incisions with big detachments of the skin and subcutaneous tissue. The use of videosurgery for the repair of these weaknesses is still controversy. Aim -To describe a new procedure using robotics in the repair of the linea alba, associating minimally invasive tecniques by Rives/Stoppa and component separation tecniques. Methods -Five patients undergone surgery in the same hospital, the same operating team and using the Da Vinci S. robotics equipment. ResultsThree women and two men undergone surgery, with no mortality. Two of these patients were re-operated due a recurrent hernia between muscle and posterior sheath that was closed in the re-access. Conclusions -The robotic procedure in the reconstruction of the linea alba showed itself feasible and aesthetically acceptable. Also, in advantage, the procedure follows the traditional principals reputable by experts of the abdominal wall trough minimally invasive surgery. Correspondência:Ricardo Zugaib Abdalla, e-mail: ricardo.abdalla@hsl.org.br Fonte de financiamento: não há Conflito de interesses: não háRecebido para publicação: Aceito para publicação:HEADINGS -Ventral hernia. Robotics. Abdominal wall. Umbilical hernia. INTRODUÇÃOO s defeitos da linha média podem ser congênitos ou adquiridos. As hérnias congênitas, epigástricas, estão presentes em 3-5% da população 5 . Alguns estudos mais recentes reportam incidência de 0,7%8. As adquiridas ocorrem de 3-20% das laparotomias medianas, com risco duplicado quando houve infecção do sítio cirúrgico 3 . Tais defeitos podem estar associados a diástase dos músculos retos do abdome acima da linha arqueada da aponeurose posterior desses músculos. É comum em obesos, pneumopatas, fumantes, idosos, desnutrido...

-Introduction:Minimally invasive videosurgery has modified anatomy dissection of diseases that are treated operatively. However, the benefit of this method has been delayed due to the lack of development of technologies and articulated movements for the abdominal wall, demanding the need for investments and time for solidification. This approach to repair the abdominal wall is based on the Rives-Stoppa principles. Technique: With the patient in supine position, a small supra pubic incision is done and the pre-peritoneal space is achieved and inflated.After the trocars are placed, the peritoneal sac is dissected and the abdominal cavity is entered, above the arcuate line. The posterior rectus sheath is liberated and a linear stapler is placed in both sides and fired, creating a midline and a retromuscular space, where the mesh is placed and fixed. Conclusion: The method is feasible, easy to perform, reproducible, saves time and with a good functional result. RESUMO -Introdução:A cirurgia minimamente invasiva modificou a maneira de analisar e dissecar os tecidos nos procedimentos cirúrgicos. No entanto, a vantagem deste método é limitada na parede abdominal, devido à falta de desenvolvimento de tecnologias e movimentos articulados para seu emprego nesta região, exigindo a necessidade de investimentos e de tempo para a solidificação. Esta abordagem para reparo operatório da parede abdominal é baseada nos princípios Rives-Stoppa. Técnica: Com o paciente em decúbito dorsal, uma pequena incisão supra-púbica é feita e o espaço pré-peritoneal é alcançado e insuflado. Após os trocárteres serem colocados, o saco peritoneal é dissecado e a cavidade abdominal é atingida acima da linha arqueada. As bainhas posteriores do músculo reto do abdome são liberadas e um grampeador linear é colocado em ambos os lados e acionado, restituindo a linha média e criando um espaço retromuscular, onde a tela é colocada e fixada. Conclusão: O método é viável, fácil de realizar e reprodutível, economizando tempo e com resultado funcional satisfatório.

The robotic surgery for obesity surgery was safe during the initial experience.

BackgroundThe laparoscopic ventral hernia repair technique made possible surgeries with smaller skin incisions and smaller dissection of the soft tissue around the hernia, therefore with a better wound, a quicker postoperative recovery and a lower complication rate.AimTo evaluate the applicability of a quality of life survey based on the molds of the American Hernia Society, European Hernia Society and Carolinas Equation for Quality of Life, through telephone in patients submitted to laparoscopic hernioplasty by IPOM technique.MethodsA retrospective cohort study was made to evaluate the quality of life of 21 patients that underwent anterior abdominal wall laparoscopic hernioplasty by intraperitoneal onlay mesh technique. Questionnaire was applied through telephone.ResultsOf the 21 patients, 19% felt that the hernia recurred. Also 19% passed through another abdominal wall surgery, and among these, 75% was related to the previously hernia correction. Finally, 81% of patients did not undergo any other abdominal wall surgery.ConclusionIt was possible to apply the quality of life questionnary by telephone on patients who underwent an anterior abdominal wall. The results, in its turn, were satisfactory and showed that patients, in general, were satisfied with the surgical procedure.

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