Ultrasound-guided Hydro-dissection Facilitates Tissue Expander Placement and Components Separation in Complex Ventral Hernia Repair

Abstract

Summary: Tissue expanders are known adjuncts in ventral hernia repair, used in a staged approach where tissue closure or coverage of the defect is preferred but inadequate. Placement of tissue expanders in the correct tissue plane can be difficult, especially in thin patients or with loss of domain. This case series describes a technique in which tissue expander placement is facilitated by ultrasound-guided hydro-dissection, following the placement of a transversus abdominis plane (TAP) block. In short, after induction of anesthesia, the same needle used for the ultrasound-guided TAP block can be repositioned by the anesthesiologist to instill tumescent solution into the fascial plane between the internal and external oblique muscles. This allows for identification of the fascial planes in the ensuing operation. Our technique may prove to be an alternative tool in the placement of tissue expanders for ventral hernia repair, or in other procedures requiring device placement.

Exploring Variable Approaches in Complex Hernia Repair: A Comprehensive Literature Review

“…It is important to note that this method has some disadvantages, including the potential for expander rupture, hernia recurrence, and complications during the removal of skin grafts such as enterotomy. It's worth mentioning that much of the evidence supporting this technique is derived from case series [ 12 , 13 ]. A systematic review conducted in 2021 analyzed 7767 patients who underwent various tissue expander procedures, including 150 cases of abdominal wall reconstruction [ 14 ].…”