THE INCIDENCE OF ADDITIONAL HERNIA DEFECTS IN A DIASTATIC LINEA ALBA, NOT REPORTED ON PRE-OPERATIVE CT IMAGING

Abstract

Abstract Aim Patients with ventral primary or incisional hernias with significant recti diastasis are frequently refered to abdominal wall reconstruction (AWR) services. We audited the rate of incidental intra-operative ventral defects related to diastatic linea alba. Method A retrospective analysis of a prospectively maintained database was carried out from March 2023 to January 2024. All patients who underwent AWR using a minimally invasive approach (MIS) were included. Data on the following variables were collected: sex, age (years), BMI (kg/m2), length of hospital stay (LOS, days), operative time (hours), and ventral defects. Results 27 patients underwent MIS AWR (22 robotic; 8 laparoscopic). Male to female ratio was 16:11. Median age was 58 years (IQR 48–66) and BMI 36 kg/m2 (IQR 32–37). All patients underwent eTEP retro-rectus Rives-Stoppa + diastasis plication using macroporous polypropylene non-absorbable synthetic mesh. Median operating time was 3.3 hours (IQR 3.1–3.5) and LOS was 2 days (IQR 1–2). 1 (3%) patient had laparoscopic converted to open procedure due to bowel involvement. 13 (48%) of patients had extra defects associated with diastatic linea alba which were not visualized in pre-operative cross-sectional imagining. Conclusion When compared to a local repair, the MIS AWR approach in patients with ventral hernias and significant diastasis is justified when considering the high likelihood of synchronous linea alba defects and therefore a risk for future recurrence. These extra defects are rarely detected on pre-operative cross-sectional images. In addition, the plication of diastasis during AWR allows surgeons to recreate a more functional linea alba.