Parietoscopic treatment of abdominal wall defects: A report of 15 cases

Abstract

The principle of parietoscopy is the creation of a subcutaneous plane of cleavage in front of the aponeuroses by insufflation of CO2. The aim is the repair of certain hernias and incisional hernias of the abdominal wall without damaging the overlying skin, mainly for cosmetic reasons, especially in young women. In our series access was suprapubic or umbilical depending on the site of the lesion to be repaired. A 10 mm blunt tip trocar was placed in contact with the aponeurotic plane. After initial separation of the subcutaneous tissue, progressive insufflation of CO2 stripped the cutaneous layer extensively upwards and laterally. Using one or two 5 mm trocars, the aponeurotic layer was progressively freed and the affected zones identified. These were repaired by standard endoparietal sutures or by percutaneous sutures using a Reverdin needle. Fifteen patients (14 women and 1 man) with a mean age of 30 years (range 19 to 35) with diastasis of the rectus abdominis muscles (5 cases), incisional hernias (3 cases) or an epigastric or linea alba hernia (7 cases) were treated by parietoscopy. Conversion to a classical approach was necessary in one man with diastasis of the rectus muscles because fibrosis prevented a subcutaneous plane of cleavage. Repair was possible in 14 cases. The mean operative duration was 1h 20 min and that of hospitalisation was 2 days (1–3). There was no mortality or morbidity. The mean follow-up was 18 months (4–40) with excellent cosmetic and functional results. Thus, abdominal parietoscopy allows repair of certain minor parietal lesions with preservation of the overlying skin. Its indications are of a cosmetic nature, in young women with normal skin overlying an abdominal wall defect.