Laparoscopic transabdominal preperitoneal approach for umbilical hernia with rectus diastasis

Capitano, Sante

doi:10.1111/ases.12365

Cited by 8 publications

(5 citation statements)

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“…Although this preperitoneal space may be rather delicate above the arcuate line and may contain insufficient connecting tissue, it can usually still be carefully and meticulously separated, establishing a sufficient extraperitoneal (preperitoneal) pocket to accommodate a large non-coated mesh for hernia repair. Several surgeons have tried to use this extraperitoneal plane for optimal mesh placement and such to avoid any violation of the rectus sheath or the linea alba [15][16][17]. However, in all of these studies, the transabdominal route for approaching this extraperitoneal space was used.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic totally extraperitoneal approach (TEA) technique for primary ventral hernia repair

Qin

Bittner

2020

Surg Endosc

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Background Up to now the totally extraperitoneal (TEP) technique is limited to the treatment of inguinal hernias. Applying this anatomical repair concept to the treatment of other abdominal wall hernias, we developed an endoscopic totally extraperitoneal approach (TEA) to treat primary midline ventral hernias, including umbilical and epigastric hernias, in which for mesh placement, an anatomical space is developed between the peritoneum and the posterior rectus sheath in the ventral part of the abdominal wall (preperitoneal space). Methods Between September 2017 and December 2019 according to the selection criterions, 28 consecutive primary midline ventral hernias were repaired using TEA. After extensive endoscopic development of the midline extraperitoneal plane, which was started in the suprasymphysic area, and reduction of the hernia sac, the hernia defect was closed and a large mesh was placed in the preperitoneal position to enforce the anterior abdominal wall. Results All operations were successfully performed without conversion to open surgery. The mean operation time was 103.3 min (range 85-145 min). Patient-reported postoperative pain was qualitatively mild with a mean pain visual analogue scale score of 1.9 on postoperative day 1. The average hospital stay was 1.9 days (range 1-3 days). Three patients developed minor complications and were treated with no long-term adverse effects. Readmissions within 30 days or hernia recurrences were not observed with a mean follow-up period of 18 months (range 10-27 months). Conclusion In selected cases, TEA is a safe and feasible minimally invasive alternative in treating primary ventral hernias. This technique preserves the anatomical and physiological structure of the abdominal wall and may significantly reduce trauma and postoperative complications. Additionally, anti-adhesion-coated meshes and fixation tackers are not required, thus being cost-effective. Further studies are necessary to proof the true clinical efficacy in comparison to well-known alternative techniques.Keywords Primary ventral hernia · Umbilical hernia · Epigastric hernia · Endoscopic repair · Totally extraperitoneal approach The totally extraperitoneal (TEP) technique for repair of inguinal hernia was first reported in 1992 by Dulucq [1] and has since been continuously refined and standardized. In fact, it has become one of the gold standard procedures for the treatment of inguinal hernia in adults. The extraperitoneal and Other Interventional Techniques

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Section: Discussionmentioning

confidence: 99%

Endoscopic totally extraperitoneal approach (TEA) technique for primary ventral hernia repair

Qin

Bittner

2020

Surg Endosc

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“…However, transfascial sutures are painful beyond the higher cost associated with intraperitoneal meshes. The closure of the defect with placement of large preperitoneal meshes to reinforce peri-hernia weakness - known as umbilical TAPP - in patients who do not need or wish to correct diastasis has recently been used 7 , 16 .…”

Section: Discussionmentioning

confidence: 99%

Subcutaneous Onlay Laparoscopic Approach (Scola) for Ventral Hernia and Rectus Abdominis Diastasis Repair: Technical Description and Initial Results

Claus

Malcher

Cavazzola

et al. 2018

ABCD, arq. bras. cir. dig.

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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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“…It is optional to simultaneously correct the diastasis; this should be discussed with the patient [28]. When seeking to prevent potential issues linked to intra-abdominal mesh positioning, the laparoscopic TAPP technique for umbilical hernia and rectus diastasis may be a safe surgical choice [29]. Shinde et al [27] examined the SCOLA with an added modification of the operating port, using spinal needles to restrict the amount of lateral dissection, and found that with little risks and postoperative morbidities, SCOLA is an effective surgery for treating umbilical/epigastric hernia with diastasis recti [27].…”

Section: Preferred Mas Procedures For Umbilical Hernia With Diastasis...mentioning

confidence: 99%

Ventral hernia repair in India: a Delphi consensus

Chowbey,

Wadhawan,

Subramanian

et al. 2024

Hernia

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Purpose While research on inguinal hernias is well-documented, ventral/incisional hernias still require investigation. In India, opinions on laparoscopic ventral hernia repair (LVHR) techniques are contested. The current consensus aims to standardize LVHR practice and identify gaps and unfulfilled demands that compromise patient safety and therapeutic outcomes. Methods Using the modified Delphi technique, panel of 14 experts (general surgeons) came to a consensus. Two rounds of consensus were conducted online. An advisory board meeting was held for the third round, wherein survey results were discussed and the final statements were decided with supporting clinical evidence. Results Experts recommended intraperitoneal onlay mesh (IPOM) plus/trans-abdominal retromuscular/extended totally extraperitoneal/mini- or less-open sublay operation/transabdominal preperitoneal/trans-abdominal partial extra-peritoneal/subcutaneous onlay laparoscopic approach/laparoscopic intracorporeal rectus aponeuroplasty as valid minimal access surgery (MAS) options for ventral hernia (VH). Intraperitoneal repair technique is the preferred MAS procedure for primary umbilical hernia < 4 cm without diastasis; incisional hernia in the presence of a vertical single midline incision; symptomatic hernia, BMI > 40 kg/m2, and defect up to 4 cm; and for MAS VH surgery with grade 3/4 American Society of Anaesthesiologists. IPOM plus is the preferred MAS procedure for midline incisional hernia of width < 4 cm in patients with a previous laparotomy. Extraperitoneal repair technique is the preferred MAS procedure for L3 hernia < 4 cm; midline hernias < 4 cm with diastasis; and M5 hernia. Conclusion The consensus statements will help standardize LVHR practices, improve decision-making, and provide guidance on MAS in VHR in the Indian scenario.

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Laparoscopic transabdominal preperitoneal approach for umbilical hernia with rectus diastasis

Abstract: The laparoscopic transabdominal preperitoneal approach for umbilical hernia and rectus diastasis may be a safe surgical option when trying to avoid potential complications related to intra-abdominal mesh positioning.

Cited by 8 publications

References 8 publications

Endoscopic totally extraperitoneal approach (TEA) technique for primary ventral hernia repair

Endoscopic totally extraperitoneal approach (TEA) technique for primary ventral hernia repair

Subcutaneous Onlay Laparoscopic Approach (Scola) for Ventral Hernia and Rectus Abdominis Diastasis Repair: Technical Description and Initial Results

Ventral hernia repair in India: a Delphi consensus

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