V-031 ETEP APPROACH FOR UMBILICAL HERNIA & GROIN HERNIA & RECTUS ABDOMINIS DIASTASIS: IS IT A GOOD OPTION?

Abstract

Aims Ventral hernias are a frequent pathology in general surgery.Its association with rectus abdominis diastasis and groin hernias is not uncommon. Currently, the minimally invasive approach of these pathologies is becoming more frequent.The retromuscular-preperitoneal approach is a good technique because of more anatomical position of the mesh, <complications and recurrences.We present the usefulness of the e-TEP approach to treat different types of hernias (ventral and groin hernias)&rectus abdominis diastasis in the same surgical procedure. Methods Video-case. Results 58-year-old man.Physical examination: umbilical hernia(4cm), rectus diastasis(4cm) and left groin-hernia.We decided to perform a laparoscopic-extraperitoneal technique(eTEP). We use 4ports(2×12mm,2×5mm).The surgery begins dissecting the left retromuscular space using a dissector-balloon.We perform the supraumbilical cross-over transecting the left posterior sheath and then the right posterior sheath and complete the dissection of the other retromuscular space. The dissection continues reducing the hernial content and after that dissecting down to the pubis, then dissecting the left groin space.After that we continue closing the anterior sheath using Stratafix (barbed suture) & posterior sheath using 2-0 V-lock suture.We placed a 3D-PVDF-mesh for left groin hernia and another 18×35cm PVDF-mesh fixed with fibrin and without drainage. The patient presented a satisfactory evolution without complications and was discharged in 1°POD. Conclusions The minimally invasive eTEP-approach is an effective and good option in cases of ventral hernias associate with inguinal hernias and rectus abdominis diastasis,without increasing the incidence of postoperative complications and with better postoperative recovery,less postoperative pain,shorter LOS,lower rates of recurrence,faster return to routine activities and working life,and lower healthcare costs.