P-046 Laparoscopic E-Tep Approach for Ventral Hernia Associated With Inguinal Hernia and Rectus Diastasis: Is It a Good Option?

Abstract

Aims Ventral hernias are a common pathology in general surgery and its association with rectus abdominis diastasis and inguinal hernias is frequent.The surgical technique for the repair of this type of hernias is ideally a retromuscular technique associated or not with a posterior separation of components (transversus abdominis muscle release-TAR).We present the utility of the e-TEP-approach to treat different types of hernias associated with rectus abdominis diastasis in the same surgical procedure. Methods 71-year-old-man,surgical-histories:open right-hernioplasty and laparoscopic-radical prostatectomy.Physical examination:midline ventral-hernia (M3W2:6cm),left-inguinal-hernia and diastasis(5cm).We decided to perform a laparoscopic-eTEP-approach. Results We use 5ports(3×12mm,2×5mm).1°step is to dissect the left retromuscular-space using a dissector balloon,and continuous with the supraumbilical cross-over transecting the left posterior-sheath and then the right posterior-sheath completing the dissection of the other retromuscular-space.The dissection continues down to the pubis dissecting the midline hernial-sac and then dissecting the left-inguinal-space.Due to the tension to close the posterior-sheath,we decided to perform a right-TAR.We begin the right-TAR up-to-down using the monopolar-electrocautery, at this area we observe adhesion due to the ports of the previous surgery.Next, we continue with the closure of the posterior and anterior-sheaths using 2–0 V-lock suture.We placed a 3D-PVDF-mesh for the left-inguinal-hernia and another 30×30cm polypropylene-mesh in the retromuscular-preperitoneal space.The patient presented a satisfactory evolution,was discharged 1°POD. Conclusions The minimally invasive e-TEP approach is an effective and good option in cases of ventral-hernias associate with inguinal-hernias and diastasis without increasing the incidence of postoperative complications and with better postoperative recovery,less postoperative pain, shorter LOS,lower rates of recurrence and lower healthcare costs.