scholarly journals P037 TOTALLY ENDOSCOPIC SUBLAY REPAIR FOR DIASTASIS RECTI AND CONCOMITANT MIDLINE HERNIA: FIRST CASE VIDEO-REPORT

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Camillo Leonardo Bertoglio ◽  
Lorenzo Morini ◽  
Simona Grimaldi ◽  
Pietro Carnevali ◽  
Giovanni Ferrari
Keyword(s):  
Polyvinylidene Fluoride ◽  
Rectus Sheath ◽  
Barbed Suture ◽  
Preperitoneal Space ◽  
Anterior Rectus Sheath ◽  
Linea Alba ◽  
First Case ◽  
Diastasis Recti ◽  
Posterior Rectus Sheath ◽  
Sublay Repair

Abstract Aim We describe in detail the step by step technique of the first case of TES repair at our institution. Methods We selected the case of a M2W3L3 hernia associated to xipho-umbilical diastasis recti in a young woman symptomatic for a progressively worsening back pain and local bulky sensation. Results The intervention is started directly with a suprapubic transverse incision of 2.5 cm and a circumferential, atraumatic retraction is inserted after a small incision of the anterior rectus sheath. Blunt dissection is further continued through this access by luxating the underlying rectus muscles to separate the preperitoneal space below the arcuate line. The pneumo-preperitoneum is then inducted through this port. Laparoscopic dissection allows for enlargement of the avascular space laterally and then two 5-mm trocars are placed on the bilateral aspects of rectus muscles. By means of a lap bipolar dissector the edge of posterior rectus sheath are incised from the arcuate line following the diastasis laterally up to the subxiphoid space. The Rives plane is recovered without opening of the linea alba. After reduction of the M2 hernia both the posterior sheath and the diastatic anterior fascia are sutured with a running long-resorbable 2/0 barbed suture. Polyvinylidene fluoride (PVDF) mesh fixed with the use of an hystoacrilic glue. Conclusion Minimally invasive extraperitoneal repair of small/medium hernia defects of the linea alba is gaining wide acceptance. Concomitant presence of rectum diastasis recti seems to be the ideal indication to approach the learning curve of such a technically demanding procedure

scholarly journals VP026 LIRA-TAPE TECHNIQUE. A NEW PROCEDURE FOR RESTORING THE MIDLINE BY MIS IN SUPRAPUBIC AND MIDDLE SIZE MIDLINE HERNIAS

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Julio Gómez-Menchero ◽  
Antonio Gila Bohorquez ◽  
Jose Luis Guerrero Ramirez ◽  
Pablo de la Herranz ◽  
Joaquin Luis García Moreno ◽  
...  
Keyword(s):  
Polyvinylidene Fluoride ◽  
Abdominal Wall Reconstruction ◽  
Rectus Sheath ◽  
Minimal Invasive ◽  
Barbed Suture ◽  
Medium Size ◽  
Invasive Approach ◽  
Posterior Rectus Sheath ◽  
Minimal Invasive Approach ◽  
Pubic Arch

Abstract Aim LIRA (Laparoscopic Intracorporeal Rectus Aponeuroplasty) was described in 2018 in order to reduce the tension in the midline as an alternative for Closing the defect (CD) during Laparoscopic Ventral Hernia Repair. TAPE (Transabdominal Partial Extraperitoneal) was described in 2011 in order to repair complex suprapubic hernias to reduce the recurrence rate. We present a case of suprapubic hernia associated to a medium-size midline hernia using LIRA combined with TAPE as a new procedure for abdominal wall reconstruction Material and Methods 50 years old female affected with a M5 W2 hernia associated to a M2-3 W2. (EHS Classification). Preoperative scan was performed. Results 3 Ports (2 of 5 mm, 1 of 12 mm) in the left mid axillary line for LIRA and supraumbilical (10 mm) and right paraumbilical (5mm) to assist TAPE were placed. A peritoneal flap is created to expose de pubic arch and the Coopeŕs Ligament. CD was performed in suprapubic defect using a barbed suture and continued for LIRA procedure in the posterior rectus sheath. An intraabdominal mesh was placed (Polyvinylidene fluoride (PVDF) mesh, Dynamesh (®)-IPOM (FEG Textiltechnik mbH, Aachen, Germany. The mesh overlapped the suprapubic arch and was fixed using helicoidal sutures and covered the whole incision in the midline. Pelvic flap covered partially the mesh. Patient was discharge in 72 h Conclusions Complex hernias close to bones, as suprapubic hernias, can be restored using a minimal invasive approach, even those associated to mid-line defects. LIRA-TAPE is a safe and reproducible association for restoring the midline with a low rate of complications.

scholarly journals Evaluation of Double Mesh Modification of Chevrel’s Technique in Management of Midline Incisional Hernia

2021 ◽  
Vol 18 (1) ◽  
pp. 18-22
Author(s):  
Hazem Nour ◽  
Hany Mohamed ◽  
Mohamed Farid
Keyword(s):  
Incisional Hernia ◽  
Subcutaneous Tissue ◽  
Rectus Sheath ◽  
Incisional Hernia Repair ◽  
Bare Area ◽  
Anterior Rectus Sheath ◽  
Prolene Mesh ◽  
Posterior Rectus Sheath ◽  
Superficial Wound ◽  
Mesh Technique

Background: Chevrel’s technique provides tensionfree repair of midline incisional hernia, but wide skin and subcutaneous dissection increases rate of complications. Here, we evaluate the double mesh modification of Chevrel’s technique in midline incisional hernia repair. Methods: 22 patients with midline incisional hernia underwent double mesh modification of Chevrel’s technique. After excision of hernial sac with minimal dissection of the skin and subcutaneous tissue, the anterior rectus sheath is incised on both sides to create medial flaps that are sutured toeach other. Both recti abdominis muscles were dissected off the posterior rectus sheath, opening the retrorectus space. Prolene mesh was fixed in the retrorectus space with prolene sutures, and tailored to cover the bare area of anterior surface of both recti muscles and fixed to the lateral flaps of the anterior rectus sheath with interrupted prolene sutures. Results: We observed no recurrences, no skin necrosis, two cases of seroma, one case of superficial wound infection and one case of temporarychronic pain. Conclusion: Double mesh modification of Chevrel technique is an efficient method for treatment of midline incisional hernia, with minimal surgical site occurrences. Keywords: Chevrel technique, Double mesh technique, Midline incisional hernia

scholarly journals REPARACIÓN ENDOSCÓPICA PREAPONEURÓTICA (REPA) DE LA DIÁSTASIS DE LOS MÚSCULOS RECTOS ASOCIADA O NO A HERNIAS DE LA LÍNEA MEDIA. ESTUDIO MULTICÉNTRICO

2019 ◽  
Author(s):  
Derlin Marcio Juárez Muas ◽  
Ezequiel Palmisano ◽  
Guillermo Pou Santoja ◽  
Salvatore Cuccomarino ◽  
Gabriel Gonzalez Higuera ◽  
...  
Keyword(s):  
Endoscopic Surgery ◽  
Intraoperative Complications ◽  
Abdominal Cavity ◽  
Barbed Suture ◽  
Oblique Muscle ◽  
Middle Line ◽  
Work Activity ◽  
Linea Alba ◽  
Average Return ◽  
Diastasis Recti

AUTORES:Juárez Muas, DerlinM1; Palmisano EzequielM2; Pou Santoja Guillermo3; Cuccomarino Salvatore4; González Higuera Luis G5; Mayo Pablo6; Martínez Maya Juan D7; Domínguez Guillermo8; Ayala Acosta Juan C9; Chichisola Agustín10.1 Salta, Argentina; 2 Rosario, Argentina; 3 Valencia, España; 4 Turín, Italia; 5 Bogotá, Colombia; 6 San Martín de Los Andes, Argentina; 7 Medellín, Colombia; 8 Buenos Aires, Argentina; 9 Bogotá, Colombia; 10 La Plata, Argentina. (Grupo Iberoamericano de Hernias)LUGAR DE TRABAJO: Hospital Público Materno Infantil. 1302 Sarmiento Ave. Salta, Argentina. Tel: 54 9 387- 432500. Ext. 4123 – Cell Phone: 54 9 387- 5175176. Mail: [email protected]: INTRODUCCIÓN:La diástasis de los rectos es una patología habitual en puerperio, asociado a hernias de la línea media. La cirugía endoscópica nos permite restaurar la línea alba. METODO: Estudio multicéntrico y prospectivo entre abril de 2014 y julio de 2018, se operaron 215 pacientes, 94% mujeres con edad promedio de 40 años. Se confirmó el diagnóstico mediante TAC (51,6%) y ecografía (45,5%).RESULTADO: La diástasis de los rectos se asoció con hernias de la línea media en 93,4%.Se diagnosticó diástasis de losrectos <50 mm (55,5%), de 51 a 80 mm (29,6%) y > 81 mm (14,9%).Se realizó plicatura de losrectos con sutura barbada.Se asocióa descarga del músculooblicuo externo en 8,8%, siendo unilateral (8%).Se colocaron mallas de polipropileno ligeras / intermedias (97,3%) y pesadas (2,7%), fijadas con agrafes absorbible (76,2%) , no absorbible (8,8%),adhesivos (7%) y puntos poliglactina 910 (8%). Se colocó drenajes en el 100%. El tiempo quirúrgico promedio 107 minutos.Complicaciones intraoperatorias (1,39%): 2 hipercapnia y 1 lesión térmica de piel umbilical. Complicaciones postoperatoria (12,5%): seroma (9,7%), hematoma preaponeurótico (1,4%).Estancia hospitalaria: 1.6 días.Retorno laboral promedio15 días.Control clínico y ecográfico a los 12 meses (58,6%), sin complicaciones ni recurrencias.CONCLUSION:La cirugía endoscópica nos permitió resolver el defecto parietal con plicatura de los rectos y prótesis preaponeurótica de refuerzo, aumentando la seguridad de la reparación, sin ingresar a la cavidad abdominal, hospitalización reducida, baja tasa de complicaciones, sin recurrencia, evidenciándose la factibilidad, seguridad y reproductibilidad de éste acceso.KEYWORDS: REPARACIÓN ENDOSCÓPICA PREAPONEURÓTICA – PLICATURA DERECTOS - DIÁSTASIS DE RECTOS REPAIR ENDOSCOPIC PREAPONEUROTICA (REPA) OF THE DIASTASIS OF THE RECTI ASSOCIATED OR NOT TO HERNIAS OF THE MIDDLE LINE. MULTI-CENTER STUDYSUMMARY:INTRODUCTION:  Diastasis of the recti is a common pathology in puerperium, associated with middle line hernias. Endoscopic surgery allows us to restore the linea alba.METHOD: Multicenter and prospective study between April 2014 and July 2018, 215 patients were operated, 94% women with an average age of 40 years. The diagnosis was confirmed by CT (51.6%) and ultrasound (45.5%).RESULT: Diastasis of the recti was associated with midline hernias in 93.4%. Diastasis of the recti were diagnosed <50 mm (55.5%), from 51 to 80 mm (29.6%) and> 81 mm (14.9%). Plication of the recti with a barbed suture was performed. It was associated with discharge of the external oblique muscle in 8.8%, being unilateral (8%). Lightweight / intermediate (97.3%) and heavy (2.7%) polypropylene meshes, fixed with absorbable (76.2%), non-absorbable (8.8%), adhesive (7%) and 910 polyglactin stitches were placed (8%). Drainage was placed in 100% of the cases. The surgical time average was 107 minutes. Intraoperative complications (1.39%): 2 hypercapnia and 1 thermal umbilical skin lesion. Postoperative complications (12.5%): seroma (9.7%), preaponeurotic hematoma (1.4%). Hospital stay: 1.6 days. Average return to work activity was of 15 days. Clinical and ultrasound check-up at 12 months (58.6%), without complications or recurrences.CONCLUSION: Endoscopic surgery allowed us to resolve the parietal defect with plication of the recti and reinforcement preapponeurotic prosthesis, increasing the safety of the repair, without entering the abdominal cavity, reduced hospitalization, low rate of complications, without recurrence, evidencing the feasibility, security and reproducibility of this approach.KAYWORDS: PREAPONEUROTIC ENDOSCOPIC REPAIR – RECTI PLICATION - DIASTASIS RECTI

scholarly journals The Relation Between the Distance of Rectus Plication and the Intra Abdominal Pressure Changes before and Immediately After Abdominoplasty

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
M A Alshafaai ◽  
H M Omran ◽  
R Z A Lashin ◽  
H K Mohammed
Keyword(s):  
Rectus Sheath ◽  
Abdominal Pressure ◽  
Inclusion Criteria ◽  
Anterior Rectus Sheath ◽  
Rectus Diastasis ◽  
Diastasis Recti ◽  
Healthy Female ◽  
Left And Right ◽  
Pressure Changes ◽  
The Relationship

Abstract Background tummy tuck surgery, also known as abdominoplasty, removes excess fat and skin and, in most cases, restores weakened or separated muscles creating and abdominal profile that is smoother and firmer. Diastasis recti means the belly sticks out because the space between left and right belly muscles has widened. The most notable symptom of anterior abdominal wall weakness or diastasis recti is a noticeable protrusion in the stomach. This protrusion is caused by weakness and separation of the muscles in the mid-abdomen. Objective It was to evaluate the relationship between the distance of recto-fascial or recto-fascial diastasis placation and intra-abdominal pressure changes during and immediately after abdominoplasty. Patient and Methodology In this study we demonstrated if there was relation between rectus diastasis width and the increase of intra-abdominal pressure, to evaluate this correlation before and immediately after the plication of anterior rectus sheath in abdominoplasty. Seventy five meeting the inclusion criteria were selected. Results This study enrolled 75 healthy female patients, the study took place at Al-Jamila Hospital, performed in a period of 10 months, starting from March 2017 till December 2017.

Intraoperative Observation during Total Extraperitoneal Repair (TEP)

2020 ◽  
Vol 86 (2) ◽  
pp. 146-151
Author(s):  
Lisheng Wu ◽  
Junsheng Li ◽  
Ran Miao
Keyword(s):  
Umbilical Artery ◽  
Vas Deferens ◽  
Rectus Sheath ◽  
Anatomical Variations ◽  
Preperitoneal Space ◽  
Anatomical Landmarks ◽  
Inferior Epigastric Artery ◽  
Epigastric Artery ◽  
Posterior Rectus Sheath ◽  
Total Extraperitoneal

We aim to observe and dissect the essential anatomical landmarks in totally extraperitoneal (TEP) procedures. Forty-six TEP procedures in 30 patients were prospectively performed in our department. During the dissection of the preperitoneal space, the following distances between landmarks were measured. D1: the distance from pubic symphysis to the arcuate line in the midline; D2: the distance from the inferior epigastric artery to the lateral border of the arcuate line (before sharp incision was performed); D3: as in D2 (but after sharp incision was performed); D4: the distance from the inferior epigastric artery to the crossing site of vas deferens and obliterated umbilical artery. Furthermore, the morphology of the posterior rectus sheath was documented. The corresponding distance between the anatomical landmarks varied greatly in each individual. D1: 8 ± 1.6 cm (range 4–10 cm). D2: 4.9 ± 0.8 cm (3.5–7 cm). D3: 6.8 ± 0.9 cm (5–9 cm). D4: 6.1 ± 1 cm (4.8–8.5 cm). Complete rectus sheath was found in 30.4 per cent (14/46) of the hernias. Anatomical variations were common in preperitoneal space. The crossing site of vas deferens and obliterated umbilical artery can serve as a landmark for dissection. Complete rectus was present in one-third of hernias, which necessitates a sharp incision for entering the correct lateral preperitoneal space.

scholarly journals P045 MEDIALIZATION AFTER COMBINED ANTERIOR AND POSTERIOR COMPONENT SEPARATION IN GIANT INCISIONAL HERNIA SURGERY, AN ANATOMICAL STUDY

2021 ◽  
Vol 108 (Supplement_8) ◽  
Author(s):  
Dimitri Sneiders ◽  
Gijs de Smet ◽  
Floris den Hartog ◽  
Laura Verstoep ◽  
Anand Menon ◽  
...  
Keyword(s):  
Incisional Hernia ◽  
Rectus Sheath ◽  
Incisional Hernia Repair ◽  
Anatomical Study ◽  
Reference Points ◽  
Component Separation ◽  
Hernia Surgery ◽  
Anterior Rectus Sheath ◽  
Posterior Component Separation ◽  
Posterior Rectus Sheath

Abstract Aim To obtain tension-free closure for giant incisional hernia repair, anterior or posterior component separation (ACS, PCS) is often performed. In extreme patients, ACS and PCS may be combined. The aim of this study was to assess the additional medialization after simultaneous ACS and PCS. Material and Methods Fresh-frozen post mortem human specimens were used. Both sides of the abdominal wall were subjected to retro-rectus dissection (Rives-Stoppa), ACS and PCS, the order in which the component separation techniques (CST) were performed was reversed for the contralateral side. Medialization was measured at three reference points. Results ACS provided most medialization for the anterior rectus sheath, PCS provided most medialization for the posterior rectus sheath. After combined CST total median medialization ranged between 5.8 and 9.2 cm for the anterior rectus sheath, and between 10.1 and 14.2 cm for the posterior rectus sheath (depending on the level on the abdomen). For the anterior rectus sheath, additional PCS after ACS provided 15% to 16%, and additional ACS after PCS provided 32% to 38% of the total medialization after combined CST. For the posterior rectus sheath, additional PCS after ACS provided 50% to 59%, and additional ACS after PCS provided 11% to 17% of the total medialization after combined CST. Retro-rectus dissection alone contributed up to 41% of maximum obtainable medialization. Conclusions ACS provided most medialization of the anterior rectus sheath and PCS provided most medialization of the posterior rectus sheath. Combined CST provides marginal additional medialization, clinical use of this technique should be carefully balanced against additional risks.

scholarly journals Experimental model to study correction of rectus diastasis by laparoscopy, in pigs

2003 ◽  
Vol 18 (spe) ◽  
pp. 69-76 ◽  
Author(s):  
Fábio Xerfan Nahas ◽  
Lydia Masako Ferreira
Keyword(s):  
Experimental Model ◽  
Rectus Sheath ◽  
Rectus Muscle ◽  
The Other ◽  
Continuous Suture ◽  
Anterior Rectus Sheath ◽  
Rectus Diastasis ◽  
Posterior Rectus Sheath ◽  
The Right ◽  
Inside Out

The use of swines as an experimental model to correct rectus diastasis by laparoscopy is described on this article. The correction of this deformity was achieved by the plication of the posterior rectus sheath with the insertion of two trocars on the inferior abdominal fold. One trocar was placed in the midline whereas the other was inserted laterally to the right rectus muscle. A continuous suture was made on the posterior rectus sheath with 0-Polipropilene. This suture was anchored at the anterior rectus sheath under direct vision. An incision of all layers was performed on the flank and the abdominal wall was turned inside out so that the area of plication could be assessed and evaluated. The experimental model described showed to be feasible to demonstrate the correction of rectus diastasis by laparoscopy.

scholarly journals A new minimally invasive technique for the repair of diastasis recti: a pilot study

2021 ◽  
Author(s):  
Gabriele Manetti ◽  
Maria Giulia Lolli ◽  
Elena Belloni ◽  
Giuseppe Nigri
Keyword(s):  
Open Access ◽  
Minimally Invasive ◽  
Abdominal Wall Defect ◽  
Rectus Sheath ◽  
Rectus Muscle ◽  
Laparoscopic Technique ◽  
Invasive Technique ◽  
Diastasis Recti ◽  
Posterior Rectus Sheath

Abstract Background Diastasis recti is an abdominal wall defect that occurs frequently in women during pregnancy. Patients with diastasis can experience lower back pain, uro-gynecological symptoms, and discomfort at the level of the defect. Diastasis recti is diagnosed when the inter-rectus distance is > 2 cm. Several techniques, including both minimally invasive and open access surgical treatment, are available. Abdominoplasty with plication of the anterior rectus sheath is the most commonly used, with the major limitation of requiring a wide skin incision. The new technique we propose is a modification of Costa’s technique that combines Rives–Stoppa principles and minimally invasive access using a surgical stapler to plicate the posterior sheaths of the recti abdominis. Methods It is a fully laparoscopic technique. The pneumoperitoneum is induced from a sovrapubic trocar, placed using an open access technique. The posterior rectus sheath is dissected from the rectus muscle using a blunt dissector to create a virtual cavity. The posterior sheets of the recti muscles are plicated using an endo-stapler. A mesh is then placed in the retromuscular space on top of the posterior sheet without any fixation. Using a clinical questionnaire, we analyzed the outcomes in 74 patients who underwent minimally invasive repair for diastasis of the rectus abdominis sheath. Results Seventy-four patients (9 men and 65 women) were treated using this technique. Follow-up was started two months after surgery. All procedures were conducted successfully. There were no major complications or readmissions. No postoperative infections were reported. There were two recurrences after six months. There was a significant reduction in symptoms. Conclusions This new method is feasible and has achieved promising results, even though a longer follow-up is needed to objectively assess this technique.

scholarly journals Mapping traction strength of the anterior rectus sheath in cadaver

2010 ◽  
Vol 25 (4) ◽  
pp. 347-349 ◽  
Author(s):  
Romar Ângelo Barbato Silveira ◽  
Fábio Xerfan Nahas ◽  
Bernardo Hochman ◽  
Felix Carlos Ocariz Bazzano ◽  
Carlos Roberto Amorim ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Rectus Sheath ◽  
Traction Force ◽  
Abdominal Wall Defects ◽  
Complete Excision ◽  
Anterior Rectus Sheath ◽  
Linea Alba ◽  
Hernia Formation ◽  
Significant Difference ◽  
Made In

PURPOSE: The tension at the aponeurotic edges of abdominal wall defects is an important factor of dehiscence and incisional hernia formation. The purpose of this study is to map and compare the traction force necessary for medial mobilization in various levels of the anterior rectus sheath in cadavers. METHODS: Twenty four adult male cadavers, raging from 22 to 59 years old, with the abdominal wall intact and without prior preservation techniques, were dissected. A complete excision of the linea alba was performed. Traction loops of 10 mm in diameter were made in the anterior rectus sheath and were placed: 2, 4, 6 and 8 cm below the lower edge of the umbilicus and 3, 6 and 9 cm above the upper edge of the umbilicus. Each loop was mobilized 10 mm in the medial direction, using an analog dynamometer. The values obtained in each level were compared using Friedman's analysis of Variance for p < 0.05. RESULTS: The average traction values obtained at the various levels were compared and there was no statistical significant difference. CONCLUSION: There is no variation in tension along the whole extension of the anterior rectus sheath.

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