OV05 CONCOMITANT MIRS (MINI INVASIVE RIVES STOPPA) AND DREAM (DIASTASIS REPAIR ENDOSCOPICALLY ASSISTED MINI-INVASIVE) FOR THE CORRECTION OF COMBINED VENTRAL HERNIA AND DIASTASIS RECTI

Abstract Aim Concomitant MIRS (Minimally Invasive Rives-Stoppa) and DREAM (Diastasis Repair Endoscopically Assisted Minimally-invasive) for the correction of combined ventral hernias and diastasis recti. Material and Methods The video shows the combined repair of umbilical hernia and diastasis correction by concomitant minimally invasive hernia repair without division of the posterior sheath and diastasis correction by parietoscopy. Results A short periumbilical incision is performed, the Alexis retractor is put in place, preaponeurotic dissection is carried out by direct access and two axial incisions of both anterior sheaths are performed parallel to and 1cm next to the midline. The umbilical hernia and one unexpected epigastric hernia are reduced and repaired by suture. Additional suture approximating the medial borders of anterior sheath incisions over the previous suture is performed to strengthen the repair. The patch is deployed in the retromuscular space superficial to the suture line, without any incision of the posterior sheath and without any fixation. Then the top of the Alexis retractor and the camera are put in place, insufflation at 10mm Hg is started and the parietoscopic step is carried out. Two 5mm trocars are placed and preaponeurotic dissection is extended up to the xiphoid process. The diastasis correction is carried out by a continuous suture approximating both rectus muscles from the xiphoid process to the umbilical hernia suture. Conclusions The MIRS technique consists of retromuscular patch repair without division of the posterior sheath, and concomitant DREAM technique reinforces the hernia repair and provides diastasis correction.

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Subcutaneous Onlay Laparoscopic Approach (SCOLA) for Umbilical Hernia with Diastasis of Rectus Abdominis Muscle: A Case Report

10.21203/rs.3.rs-497788/v1 ◽

2021 ◽

Author(s):

Halil Afsin Tasdelen

Keyword(s):

Umbilical Hernia ◽

Video Clip ◽

Laparoscopic Approach ◽

Rectus Abdominis ◽

High Recurrence Rate ◽

Anatomical Landmarks ◽

Rectus Abdominis Muscle ◽

Hernia Defect ◽

Diastasis Recti ◽

Ventral Hernias

Abstract Diastasis of the rectus abdominis muscles (DRAM) is a common pathology, usually associated with midline abdominal wall hernias. The midline ventral hernias with diastasis have a significantly high recurrence rate, so repairing the hernia defect and the diastasis should be considered. Claus et al. previously described the subcutaneous onlay laparoscopic approach (SCOLA). We report a case of diastasis recti associated with umbilical hernia repaired with SCOLA technique. A 46-year-old male patient presented with a disturbing bulge in the upper midline and painful umbilical swelling. The CT scan followed by physical examination revealed 28 mm. umbilical hernia and 35 mm. diastasis recti. We aimed to introduce the SCOLA technique using a narrated video clip and showed all the critical steps and anatomical landmarks in the video. The postoperative period was uneventful, and the patient was discharged on the second postoperative day. The SCOLA technique is a feasible and reproducible alternative for the repair of midline hernias associated with DRAM.

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Umbilical hernia, epigastric hernia and diastasis recti: an open discussion

Hernia ◽

10.1007/s10029-021-02436-2 ◽

2021 ◽

Author(s):

G. Campanelli

Keyword(s):

Umbilical Hernia ◽

Epigastric Hernia ◽

Diastasis Recti ◽

Open Discussion

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P076 DIFFERENT SURGICAL APPROACH IN DIASTASIS RECTI REPAIR: IMPORTANCE OF AN OVERALL VIEW OF THE DISEASE

British Journal of Surgery ◽

10.1093/bjs/znab395.072 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Federico Fiori ◽

Francesco Ferrara ◽

Daniele Gentile ◽

Caterina Baldi ◽

Laura Benuzzi ◽

...

Keyword(s):

Minimally Invasive ◽

Surgical Approach ◽

Complication Rate ◽

Surgical Complications ◽

Umbilical Hernia ◽

Surgical Approaches ◽

Anterior Repair ◽

Linea Alba ◽

Diastasis Recti ◽

Critical Issues

Abstract Aim Diastasis Recti (DR) is characterized by a defect of the linea alba sometimes associated with midline hernias, and frequent lipocutaneous excess. We present our experience in the treatment of diastasis recti with Inter Recti Distance (IRD) > 50mm -with or without umbilical hernia- by 3 different approaches. Material and Methods From January 2018 to February 2020, 104 patients were referred to our unit for clinical and radiological diagnosis of DR with IRD > 50 mm. Three different surgical approaches were used, based on presence of lipocoutaneous excess: laparoabdominoplasty, laparominiabdominoplasty and minimally-invasive/endoscopic with Totally Sublay Anterior Repair (TESAR) approach. Results We performed 28 TESAR (29.8%), 44 laparoabdominoplasties (42.3%) and 32 laparominiabdominoplasties (30.8%). Overall complication rate was 26% (27 patients). In 3 (2.9%) cases major surgical complications (Clavien-Dindo 3-4) occurred, all for open operations. Minor complications (Clavien-Dindo 1-2) included: 13 cutaneous ischemia, 10 small muscular hematomas and 1 subcutaneous seroma. The overall median post-operative stay was 3 days (range 2 – 14 days), and 3, 4 and 3 days for TESAR, laparoabdominoplasty and laparominiabdominoplasty groups, respectively. No recurrence registered to date. Conclusions Our experience shows the importance of an overall view of the functional and cosmetic impairment created by the DR. The surgeon must obtain an optimal functional outcome also aiming for the best cosmetic result. Therefore different approaches have to be considered, tailored to the clinical, instrumental and psychological aspects of the disease. The complication rate, while in line with the literature, emphasize how in this type of operation the critical issues of functional as well as morphological surgery coexist.

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Is mesh always necessary in every small umbilical hernia repair? Comparison of standardized primary sutured versus patch repair: retrospective cohort study

Hernia ◽

10.1007/s10029-020-02170-1 ◽

2020 ◽

Cited By ~ 5

Author(s):

K. Mitura ◽

M. Skolimowska-Rzewuska ◽

A. Rzewuska ◽

D. Wyrzykowska

Keyword(s):

Cohort Study ◽

Hernia Repair ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Umbilical Hernia ◽

Patch Repair ◽

Umbilical Hernia Repair

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Paraumbilical/Umbilical Hernia

10.5772/intechopen.96186 ◽

2021 ◽

Author(s):

Andrea Sanna ◽

Luca Felicioni

Keyword(s):

Minimally Invasive ◽

Hernia Repair ◽

Umbilical Hernia ◽

Treatment Options ◽

Management Strategies ◽

Operative Management ◽

Minimally Invasive Techniques ◽

Comprehensive Review ◽

Umbilical Hernia Repair ◽

Invasive Techniques

Umbilical hernia is a common pathology that occurs in around 2% of the population. About 10% of abdominal hernias are umbilical hernias and umbilical hernia repair is among the most commonly performed surgeries in adults. The diagnosis is straightforward when tissues or organs such as the omentum or a bowel segment bulge out through an opening in the muscles of the abdominal wall in the umbilical region. The treatment options for umbilical hernia include non-operative and operative management strategies via open or minimally invasive techniques. This chapter provides a comprehensive review of umbilical hernias in adults.

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P135 ESTABLISHMENT OF MINIMALLY INVASIVE VENTRAL HERNIA REPAIR WITH EXTRAPERITONEAL MESH PLACEMENT AS A STANDARD APPROACH OF VENTRAL HERNIA REPAIR USING THE ROBOTIC PLATFORM

British Journal of Surgery ◽

10.1093/bjs/znab395.128 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Björn Mück ◽

Frank Heinzelamann ◽

Robert Vogel ◽

Peter Büchler

Keyword(s):

Minimally Invasive ◽

Hernia Repair ◽

Ventral Hernia ◽

Open Surgery ◽

Ventral Hernia Repair ◽

Invasive Technique ◽

Mesh Implantation ◽

Mesh Placement ◽

Intraperitoneal Mesh ◽

Ventral Hernias

Abstract Aim Several meta-analyses indicated, that extraperitoneal mesh placement in the retromuscular or preperitoneal space shows advantages over intraperitoneal mesh placement. Previous surgical interventions which included extraperitoneal mesh placement were usually performed using open surgery. For several years now, our hospital has pursued to treat ventral hernias using a minimally invasive approach with extraperitoneal mesh placement. A Da Vinci X system has been available since the beginning of 2019. The aim of this analysis is to show the process of changing the operative procedure in ventral hernia repair over the period from 2016 to 2020. Material and Methods All hernia operations from 2016-2020 were evaluated using our hospitals information system. Every surgical intervention which included ventral hernia repair with the indication for mesh implantation was taken into the analysis. Results In 2016, the proportion of minimally invasive procedures was 36.67%. In all of these cases an intraperitoneal mesh was implanted in the abdominal cavity (laparoscopic IPOM operation). Open surgery was performed in 63.33%, out of which we implanted an intraperitoneal mesh in 23.68%, a retromuscular mesh in 73.68% and an onlay mesh in 2.63% of the cases. In 2020, the proportion of minimally invasive operations was already 87.5%, of which 83.33% were performed robotically assisted and 16.67% laparoscopically. In 94.29% of the minimally invasive operated patients an extraperitoneal mesh implantation was carried out, among which 75.76% were placed in the retromuscular and 24.24% in the preperitoneal position. Conclusions The majority of elective operations on ventral hernias can be performed in a minimally invasive technique with retromuscular mesh placement, using the robot.

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