Total endoscopic-assisted linea alba reconstruction (TESLAR) for treatment of umbilical/paraumbilical hernia and rectus abdominus diastasis is associated with unacceptable persistent seroma formation: a single centre experience.

Abstract

Umbilical hernia with concomitant rectus abdominus diastasis (RAD) is potentially associated with higher recurrence. Open and laparoscopic techniques have already been described, however, recent endoscopic methods show great promise. Therefore, our aim was to establish the risks and benefits of performing total endoscopic-assisted linea alba reconstruction (TESLAR). A retrospective review from 28/03/2018 to 01/05/2019 of TESLAR patients was undertaken. Data collected included medical history, operative notes and postoperative course. Statistical analyses were performed using univariate analysis. Operative technique began with a subcutaneous dissection from the lateral borders of anterior rectus sheath, lower costal margin, and pubic bone. The defect was defined and subsequently reduced. Anterior rectus sheath was subsequently plicated and if a mesh was inserted, an on-lay mesh was placed. 21 patients were identified with an 8:13 male to female ratio. Mean age and BMI were 53.1 and 29.7, respectively. 19/21 patients reported post-operative complications requiring reintervention. 17/21 patients had a seroma, all requiring draining with a minority (5/21) requiring formal excision. Univariate analysis showed age (p < 0.001), BMI (p < 0.001) and female gender (p = 0.022) were significantly associated with repeated number of seroma aspirations. TESLAR is associated with high rates of seroma and reintervention, including revisional surgery. Open repair should be considered as an alternative strategy for hernia and RAD repair.