Zylindrische abdominoperineale Rektumexstirpation mit partieller Vulva- und Vaginaresektion sowie perinealer und vaginaler Defektrekonstruktion durch einen vertikalen Rectus-abdominis-Muskel-Haut-Lappen (VRAM-Lappen)

Zusammenfassung Einleitung Patienten mit sehr tief sitzenden Rektum- oder Analkarzinomen, bei denen eine abdominoperineale Rektumexstirpation (APE) durchgeführt werden muss, profitieren von einer Erweiterung der Resektion und der damit verbundenen Vermeidung des sog. „Coning“ im Levatorenbereich. Diese von T. Holm entwickelte Technik der zylindrischen APE hat zu einer deutlichen Reduktion der Rate an intraoperativen Tumorperforationen sowie der positiven zirkumferenziellen Resektionsränder und konsekutiv zu einer erniedrigten Lokalrezidivrate geführt. Aufgrund des Auftretens von Wundheilungsstörungen in bis zu 60% aller Fälle hat sich die Verwendung myokutaner Lappenplastiken vor allem nach neoadjuvanter Radiotherapie bewährt. Derartige Lappenplastiken liefern ausreichend Füllsubstanz für Hohlräume, ergänzen vaskularisiertes Gewebe in vorbestrahlten Regionen, erleichtern den Wundverschluss und ermöglichen vaginale und perineale Rekonstruktionen. In diesem Video wird das Prinzip der zylindrischen APE mit Erweiterung durch eine partielle Vulva- und Vaginaresektion sowie nachfolgender Rekonstruktion der vaginalen Hinterwand und des vulvoperianalen Defekts mit einem vertikalen Rectus-abdominis-Muskel-Haut-Lappen (VRAM-Lappen) dargestellt. Indikation Lokal fortgeschrittenes Analkarzinom mit Infiltration und Fistel zur posterioren Vagina ohne Hinweis auf eine Fernmetastasierung bei Zustand nach neoadjuvanter Radiochemotherapie. Operation Erweiterte zylindrische abdominoperineale Rektumexstirpation mit partieller Vulva- und Vaginaresektion, Anlage eines endständigen Descendostomas mit parastomaler, intraperitonealer Onlay-Mesh-Augmentation (IPOM), vaginale und perineale Rekonstruktionen mit einem VRAM-Lappen rechts und Inlay-Netzaugmentation des vorderen Rektusscheidenblatts rechts. Zusammenfassung Die extralevatorische APE ist aus onkologischer Sicht der herkömmlichen Technik überlegen. Die Verwendung myokutaner Lappenplastiken verbessert die postoperative Wundheilung und Lebensqualität.

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Abdominal incision defect following AAA-surgery (AIDA): 2-year results of prophylactic onlay-mesh augmentation in a multicentre, double-blind, randomised controlled trial

Updates in Surgery ◽

10.1007/s13304-021-01125-0 ◽

2021 ◽

Author(s):

S. Honig ◽

H. Diener ◽

T. Kölbel ◽

W. Reinpold ◽

A. Zapf ◽

...

Keyword(s):

Incisional Hernia ◽

Controlled Trial ◽

Fascial Closure ◽

Absorbable Suture ◽

Double Blind ◽

Midline Laparotomy ◽

Mesh Augmentation ◽

Onlay Mesh ◽

Randomised Controlled

AbstractThe reported incidence of incisional hernia following repair of abdominal aortic aneurysm (AAA) via midline laparotomy is up to 69%. This prospective, multicenter, double-blind, randomised controlled trial was conducted at eleven hospitals in Germany. Patients aged 18 years or older undergoing elective AAA-repair via midline incision were randomly assigned using a computer-generated randomisation sequence to one of three groups for fascial closure: with long-term absorbable suture (MonoPlus®, group I), long-term absorbable suture and onlay mesh reinforcement (group II) or extra long-term absorbable suture (MonoMax®, group III). The primary endpoint was the incidence of incisional hernia within 24 months of follow-up, analysed by intention to treat. Physicians conducting the postoperative visits and the patients were blinded. Between February 2011 and July 2013, 104 patients (69.8 ± 7.7 years) were randomised, 99 of them received a study intervention. The rate of incisional hernia within 24 months was not significantly reduced with onlay mesh augmentation compared to primary suture (p = 0.290). Furthermore, the rate of incisional hernia did not differ significantly between fascial closure with slow and extra long-term absorbable suture (p = 0.111). Serious adverse events related to study intervention occurred in five patients (5.1%) from treatment groups II and III. Wound healing disorders were more frequently seen after onlay mesh implantation on the day of discharge (p = 0.010) and three (p = 0.009) and six (p = 0.023) months postoperatively. The existing evidence on prophylactic mesh augmentation in patients undergoing AAA-repair via midline laparotomy probably needs critical review. As the implementation of new RCTs is considered difficult due to the increasing number of endovascular AAA treated, registry studies could help to collect and evaluate data in cases of open AAA-repair. Comparisons between prophylactic mesh implantation and the small bite technique are also required. Trial registration: ClinicalTrials.gov Identifier: NCT01353443. Funding Sources: Aesculap AG, Tuttlingen, Germany.

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Endoscopic-Assisted Linea Alba Reconstruction plus Mesh Augmentation for Treatment of Umbilical and/or Epigastric Hernias and Rectus Abdominis Diastasis – Early Results

Frontiers in Surgery ◽

10.3389/fsurg.2016.00027 ◽

2016 ◽

Vol 3 ◽

Cited By ~ 15

Author(s):

Ferdinand Köckerling ◽

Marinos Damianos Botsinis ◽

Christine Rohde ◽

Wolfgang Reinpold

Keyword(s):

Rectus Abdominis ◽

Linea Alba ◽

Early Results ◽

Mesh Augmentation

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ABDOMINAL RECTUS DIASTASIS (ARD) CORRECTION FOR PAIN REDUCTION AND IMPROVEMENT OF ABDOMINAL WALL MUSCLE STRENGTH

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v4i1.870 ◽

2020 ◽

Vol 4 (1) ◽

Author(s):

Kaustubh Vasant Waikar

Keyword(s):

Muscle Strength ◽

Abdominal Wall ◽

Training Group ◽

Rectus Abdominis ◽

Operative Repair ◽

Rectus Diastasis ◽

Wall Strength ◽

Collagen Iii ◽

Mesh Augmentation ◽

Computed Tomography Scanning

Introduction: Rectus abdominis diastasis (RAD) can be described as a condition in which rectus abdominis muscles are separated by an abnormally wide distance i.e. any separation of more than 2 cm is considered to be abnormal. Several aetiological factors may lead to protrusion of the anterior abdominal wall. It is a common complaint in women after childbirth. Abdominal rectus diastasis (ARD) is a sequele of the expansion of the abdominal contents during pregnancy or massive weight loss and/or congenital disproportion of the collagen III/I ratio. Operative repair of ARD can improve abdominal wall function. Various methods for ARD repair have been described. These differ by approach like open versus laparoscopic, the position of suture placement, numbers of layers of sutures, suture material, and use of mesh. Also it can be combined with mesh augmentation in the IPOM technique for enhanced stabilization of the abdominal wall. Material and Methods: Eligible patients were randomized to either one of two operative procedures or a 3-month, dedicated training program which serve as a control group. ARD width was assessed clinically and confirmed with computed tomography scanning. Endpoints were assessed after 6 months for relapse of the ARD, pain, restriction of daily activities and improvement in muscle strength. Abdominal wall strengthe was assessed by Visual analogue scale (VAS). Results: A total of 72 patients were enrolled into the study (70 female and 2 male). 24 patients were enrolled in each group. 13 patients had undergone cesarean section in the Quill group and 12 in the mesh group. According to VAS scale no statistically significant difference was seen between the two operative groups regarding perceived improvement in abdominal wall strength. But it was significantly higher in operated group as compared to training group. Abdominal muscular strength was improved in all the three groups. Improvement in abdominal wall strength was lower in training group compared to operative groups. No relapse was observed in operative groups. Conclusion: Operative repair of ARD can provide functional stability and improvement in pain and physical parameters it also improves quality of life, and reduce functional disability. Keywords: ARD, Quill SRS, Mesh repair, VAS, linea alba (LA)

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