Abstract
SummaryBackgroundPatients with symptomatic umbilical, trocar, and/or epigastric hernias and concomitant rectus abdominis diastasis represent a growing clinical problem. The optimal management of this complex hernia situation is the subject of debate in the literature. This paper reports the early results of an innovative surgical technique aimed at managing this hernia situation.MethodsEndoscopic-assisted linea alba reconstruction (ELAR) with mesh augmentation is a surgical technique long known in the literature for its good outcome for incisional hernia repair (myofascial release, overlapping herniorrhaphy, Gibson’s operation, shoelace repair, anterior rectus sheath repair, dynamic patch plasty) via a small access route. The early results for 140 patients are presented here.ResultsTwo patients (1.4%) developed postoperative complications requiring redo surgery. These were two cases of diffuse secondary bleeding without an identifiable bleeding source, in one patient with liver cirrhosis and portal hypertension and in another patient receiving treatment with platelet aggregation inhibitors. All other complications were successively managed with conservative treatment. After 1 year, two of 30 patients reported occasional pain, including pain at rest in one patient.ConclusionThe ELAR technique with mesh augmentation is an innovative, minimally invasive surgical procedure for treatment of patients with a complex abdominal wall hernia comprising symptomatic umbilical, trocar, and/or epigastric hernias with concomitant rectus abdominis diastasis.
Highlights
Rectus abdominis diastasis (RAD) describes a condition in which the two rectus muscles are separated by an abnormally wide distance of more than 2 cm [1]
The authors concluded that umbilical and/or epigastric hernias, regardless of size, with concomitant RAD require mesh repair owing to unacceptably higher recurrence rates [2]
Any concomitant development of umbilical hernias, epigastric hernias, and trocar hernias often leads to symptomatic RAD
Summary
Rectus abdominis diastasis (RAD) describes a condition in which the two rectus muscles are separated by an abnormally wide distance of more than 2 cm [1]. When a patient with RAD raises his or her head and begins to sit up, the increase in intra-abdominal pressure as the two rectus muscles contract can result in a diffuse fusiform bulge [1]. Rectus abdominis diastasis is often seen in umbilical and/or epigastric hernia (45%) [2]. Patients with small umbilical and/or epigastric hernia with concomitant RAD, who underwent suture repair, had a significantly higher recurrence rate (31.2% vs 8.3%; p < 0.001) [2]. The authors concluded that umbilical and/or epigastric hernias, regardless of size, with concomitant RAD require mesh repair owing to unacceptably higher recurrence rates [2]. Anatomic reconstruction with mesh augmentation is needed for effective repair and to prevent recurrence
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