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

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

Download Full-text

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

British Journal of Surgery ◽

10.1093/bjs/znab395.035 ◽

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

Download Full-text

Experimental research on the origin of adhesions in the abdominal cavity after operations

Journal of obstetrics and women s diseases ◽

10.17816/jowd55504-507 ◽

2020 ◽

Vol 5 (5) ◽

pp. 504-507

Author(s):

N. Aleksenko

Keyword(s):

Experimental Research ◽

Inflammatory Process ◽

Abdominal Cavity ◽

Abdominal Wound ◽

Middle Line ◽

Clinical Observations

Fusion of intestines and omentum after surgery, mainly with an abdominal wound, is a frequent phenomenon, proven by a number of clinical observations during repeated operations in the same subjects. Meanwhile, the question of the reasons for such a phenomenon, despite attempts to experimentally resolve it (Snger, Dembowski, Kelterborn), remains open to this day. According to the opinion of the last mentioned authors, the main cause of adhesions in the abdominal cavity after operations is infection, the accretion of the omentum to the middle line is caused by the release of air and the local inflammatory process; further - sloughing of the epithelium and scars of the peritoneum in uncomplicated cases do not give adhesions, ligatures in the abdominal cavity for the most part also do not cause adhesions, but show a tendency to encapsulate.

Download Full-text

Laparoscopic Davydov Procedure for Creation of Neovagina in MRKH Syndrome

BioScientia Medicina ◽

10.32539/bsm.v5i3.348 ◽

2021 ◽

Vol 5 (3) ◽

pp. 809-813

Author(s):

Ratih Krisna ◽

Rizky Agustria

Keyword(s):

Intraoperative Complications ◽

Abdominal Cavity ◽

Operating Time ◽

Vaginal Wall ◽

Primary Amenorrhea ◽

Mrkh Syndrome ◽

Gynecological Disorders ◽

Interrupted Suture ◽

Sexual Characteristics ◽

Vaginal Canal

Introduction: The Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a condition in which there is an absence of the uterus and the upper part (2/3) of the vagina. Women with MRKH syndrome show normal development of secondary sexual characteristics and a normal 46, XX karyotype. MRKH syndrome is a common cause of primary amenorrhea. Ultrasonography examination confirms kidneys, presence of the ovaries, and absence of uterus. Treatment should include a multidisciplinary approach to create a functional vagina. One of the procedures is laparoscopic Davydov vaginoplasty. Aim: To report MRKH syndrome case treated with laparoscopic Davydov vaginoplasty. Method: Ms. A, 21 years old, P0A0, came to FER clinic Moh. Hoesin Hospital Palembang with complaint, never had menstruation, the patient admitted her breast, and her pubic had growth. She wants to get married in the next six months. From the US result, there was non visualized uterus, genital band (+), and both ovaries within normal limit ~ MRKH Syndrome. Karyotype Examination: 46, XX. Patient was diagnosed with primary amenorrhea caused by MRKH syndrome and was planned for neovagina (Davydov Procedure). Result: A woman 21-year-old, P0A0, was diagnosed with primary amenorrhea caused by MRKH syndrome. The Davydov procedure was done to create a neovagina. Intraoperative, after protrusion of the wood mold as a marker shown, an incision is made to the left and right side so that the mold penetrates the abdominal cavity, then the mold is pulled into the vaginal canal slowly. The anterior and posterior peritoneal layers are drawn into the vaginal canal. The anterior and posterior peritoneal layers were withdrawn with an ovum clamp and then interrupted suture. The anterior and posterior peritoneal layers were sutured in a circular method to form a vaginal cuff. The vaginal wall is sutured (interrupted) to hold mold fixed. Conclusion: MRKH syndrome is a disorder that occurs in females and mainly affects the reproductive system. This condition causes the vagina and the uterus to be underdeveloped or even absent at birth. Patients with diagnosed MRKH syndrome require interdisciplinary care. Davydov procedure is a laparoscopically-assisted technique, which has an advantage over traditional approaches. It has shorter operating time, lower intraoperative complications, shorter hospital stay, and no external scars. Postoperatively, sexual function is similar to women without gynecological disorders.

Download Full-text

VP019 TESAR - TOTALLY ENDOSCOPIC SUBLAY ANTERIOR REPAIR - IN MIDLINE DEFECTS REPAIR

British Journal of Surgery ◽

10.1093/bjs/znab395.155 ◽

2021 ◽

Vol 108 (Supplement_8) ◽

Author(s):

Federico Fiori ◽

Feancesco Ferrara ◽

Daniele Gentile ◽

Paolo Boati ◽

Matteo Calì

Keyword(s):

Operative Time ◽

Intraoperative Complications ◽

Endoscopic Approach ◽

Anterior Repair ◽

Exclusion Criteria ◽

Diastasis Recti ◽

Midline Defects ◽

Previously Treated ◽

The Mean ◽

Invasive Techniques

Abstract Aim In recent years, many minimally invasive techniques have been presented in abdominall wall repair. Since 2018 we have been using TESAR techinque, an anterior endoscopic approach with mesh sublay, published in 2019 from our group. Material and Methods From May 2018 to May 2021 58 Patients referred to our Unit for clinical and radiological diagnosis of ventral defect (Midline hernia, Incisional hernia, Diastasis Recti>5 cm). Exclusion criteria were: maximum defeact width 8 cm, and contraindications to general anesthesia Results All the patients underwent midline repair with TESAR technique. Three TAR were performed, with defect of 8 cm width previously treated with botox. No conversion to laparotomy occured, no intraoperative complications were registered. Total mean operative time was 156 +- 21,5 min. No postoperative major complications, 3 subcoutaneous seromas occurred ,all treated conservatively. The mean Hospital stay was 2.7 + 0.8 days. Conclusions TESAR is a feasible technique for extraperitoneal repair of midline defects with a totally endoscopic approach, allowing a safe repair with good outcomes in terms of resolutions of symtoms and postoperative complications. The video shows the main steps of the technique in diastasis recti and complicated ventral hernia repair.

Download Full-text

Anterior cervical discectomy and interbody fusion by endoscopic approach: a preliminary report

Journal of Neurosurgery Spine ◽

10.3171/spi-08/01/017 ◽

2008 ◽

Vol 8 (1) ◽

pp. 17-21 ◽

Cited By ~ 12

Author(s):

Jiangwei Tan ◽

Yanping Zheng ◽

Liangtai Gong ◽

Xinyu Liu ◽

Jianmin Li ◽

...

Keyword(s):

Disc Herniation ◽

Endoscopic Surgery ◽

Interbody Fusion ◽

Intraoperative Complications ◽

Postoperative Hemorrhage ◽

Endoscopic Approach ◽

Anterior Cervical Discectomy ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Cervical Discectomy

Object The authors report the short-term results of anterior cervical discectomy and interbody fusion performed via an endoscopic approach. Methods Thirty-six patients who underwent anterior cervical discectomy and fusion (ACDF) performed using endoscopic surgery were selected for this study. The indications for surgery were cervical disc herniation caused by neck injury, spondylotic myelopathy, cervical radiculopathy, and solitary ossification of the posterior longitudinal ligament (OPLL). The involved levels included C3–4, C4–5, C5–6, and C6–7. The working channel was inserted through a 20-mm transverse incision, the protruding discs or area of OPLL were excised for complete decompression, and then an appropriate intervertebral polyetheretherketone fusion cage was implanted. Results The time spent in surgery was 120 minutes on average (range 50–150 minutes), and the mean blood loss was 55 ml (range 20–140 ml). There were no intraoperative complications and no symptoms of irritation in the laryngopharynx after surgery. However, postoperative hemorrhage of the incision occurred in 1 case. The follow-up period ranged from 26–50 months (mean 38.5 months). Postoperative Japanese Orthopaedic Association and visual analog scale scores improved significantly. Conclusions Endoscopic surgery for ACDF can produce satisfactory results in patients with cervical disc herniation, cervical myelopathy, or radiculopathy. The optimal levels for this procedure are C4–5 and C5–6. Compared with a traditional approach, this technique has great advantages in terms of cosmetic results, intraoperative visualization, and postoperative recovery course. Nevertheless, every precaution should be taken to avoid possible complications, such as postoperative hemorrhage.

Download Full-text

Robotics for Natural Orifice Transluminal Endoscopic Surgery: A Review

Journal of Robotics ◽

10.1155/2012/512616 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 10

Author(s):

Xiaona Wang ◽

Max Q.-H. Meng

Keyword(s):

Laparoscopic Surgery ◽

Postoperative Pain ◽

Endoscopic Surgery ◽

Surgical Procedure ◽

State Of The Art ◽

Abdominal Cavity ◽

Natural Orifice ◽

Robotic Platforms ◽

Flexible Instruments ◽

Natural Orifices

Natural Orifice Transluminal Endoscopic Surgery (NOTES) involves accessing the abdominal cavity via one of the bodies’ natural orifices, for example, mouth, anus, or vagina. This new surgical procedure is very appealing from patients’ perspectives because it eliminates completely abdominal wall aggression and promises to reduce postoperative pain, in addition to all other advantages brought by laparoscopic surgery. However, the constraints imposed by both the mode of access and the limited technology currently available make NOTES very challenging for the surgeons. Redesign of the instruments is imperative in order to make this emerging operative access safe and reproducible. In this paper, we survey on the state-of-the-art devices used in NOTES and introduce both the flexible instruments based on improvement of current endoscopic platforms and the revolutionary concept of robotic platforms based on the convergence of communication and micromechatronics technologies. The advantages and limitations of each category are addressed. Potential solutions are proposed to improve the existing designs and develop robust and stable robotic platforms for NOTES.

Download Full-text

Laparoscopic Davydov Procedure for Creation of Neovagina in MRKH Syndrome

BioScientia Medicina ◽

10.32539/bsm.v5i9.348 ◽

2021 ◽

Vol 5 (9) ◽

pp. 837-841

Author(s):

Ratih Krisna ◽

Rizky Agustria

Keyword(s):

Intraoperative Complications ◽

Abdominal Cavity ◽

Operating Time ◽

Vaginal Wall ◽

Primary Amenorrhea ◽

Mrkh Syndrome ◽

Gynecological Disorders ◽

Interrupted Suture ◽

Sexual Characteristics ◽

Vaginal Canal

Download Full-text

Uterine torsion in the mare: diagnosis, operation methods and prognosis

Medycyna Weterynaryjna ◽

10.21521/mw.5633 ◽

2017 ◽

Vol 73 (2) ◽

pp. 124-128

Author(s):

Maciej Witkowski ◽

Bernard Turek ◽

Marek Tischner

Keyword(s):

Digestive System ◽

Abdominal Cavity ◽

Uterine Wall ◽

The Other ◽

Midline Laparotomy ◽

Linea Alba ◽

Clinical Observations ◽

Uterine Torsion ◽

Risk Of Rupture ◽

Spontaneous Delivery

The aim of the study was to present clinical observations regarding the reposition of uterine torsion in pregnant mares. Treatments were performed in 10 mares hospitalized with a diagnosis of uterine torsion in the period from the 8th to the 11th month of pregnancy, including one mare treated during delivery. In 4 mares, obstetric examination revealed the presence of dead fetuses. In one mare admitted during labor, Kamer's repositioning technique was applied by inserting a hand through the vagina into the uterus. In all other cases, mares underwent surgical repositioning after laparotomy performed in linea alba. In 4 mares, in which the uterine wall was at risk of rupture during handling because of advanced changes, a caesarean section was performed before repositioning. Eight out of the 9 mares survived treatment and recovered without complications. One of five mares in which live fetuses were left, miscarried, while the other four delivered healthy foals. Uterine torsion reposition by midline laparotomy offers the best possibilities for inspecting the abdominal cavity, including the uterus, and for detecting any other abnormalities of the digestive system. In the case of mares in which fetuses were left, spontaneous delivery had no adverse effect on the healing of the wound.

Download Full-text

Physiotherapy in diastasis of the rectus abdominis muscle for woman during pregnancy and postpartum – a review paper

Rehabilitacja Medyczna ◽

10.5604/01.3001.0013.5015 ◽

2019 ◽

Vol 23 (3) ◽

pp. 31-38

Author(s):

Dominika Gruszczyńska ◽

Aleksandra Truszczyńska-Baszak

Keyword(s):

Multiple Pregnancy ◽

Abdominal Muscle ◽

Rectus Abdominis ◽

Google Scholar ◽

Rectus Abdominis Muscle ◽

Linea Alba ◽

Diastasis Recti ◽

Initial Stage ◽

Pregnancy And Postpartum ◽

The Right

Introduction: Diastasis recti abdominis (DRA) is defined as the increase between two abdominal rectal muscles located on both sides of the linea alba at the height of the navel. It occurs in pregnant and postpartum women due to the loosening of the linea alba during pregnancy under the influence of hormones and the developing foetus. The most common risk factors for dehiscence are: large foetus, large volume of foetal waters, multiple pregnancy, excessive abdominal muscle overload during the third trimester, obesity and too intense pressure during delivery. Study aim: The aim of the study was to present diagnostics and surgical as well as non-operative treatment for women with abdominal muscle diastasis due to pregnancy and during the puerperium period. Diagnosis of dehiscence primarily includes palpation, calliper measurements, ultrasound and CT scan. Materials and methods: Scientific bases such as Pubmed, Sciencedirect, Google Scholar and Ebsco were searched. Results: A total of 48 scientific reports from Pubmed, Sciencedirect and Google Scholar were collected. Conclusions: Diastasis of the rectus abdominis muscle can be treated preventively by introducing appropriate prophylaxis, which aims to strengthen the transverse and the rectus abdominis muscles, as well as learning the right posture and principles of proper performance of activities such as lifting heavy objects. In the event of diastasis occurring in the puerperium period, its size can be reduced in a non-invasive manner or even completely eliminated after introducing appropriate exercises, being supported with orthopaedic equipment if necessary. Exercises should be individually selected by a therapist and performed under his/her supervision at the initial stage of training to teach the patient to properly activate the transverse abdominal muscle. Pregnant women who do not have contraindications to physical activity can reduce the risk of the DRA by performing appropriate exercises.

Download Full-text

Simplified Minimally Invasive Surgical Approach for Prophylactic Laparoscopic Gastropexy in 21 Cases

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6879 ◽

2019 ◽

Vol 55 (3) ◽

pp. 152-159 ◽

Cited By ~ 4

Author(s):

Claire Deroy ◽

Harriet Hahn ◽

Camille Bismuth ◽

Guillaume Ragetly ◽

Eymeric Gomes ◽

...

Keyword(s):

Intraoperative Complications ◽

Abdominal Ultrasound ◽

Abdominal Discomfort ◽

Transversus Abdominis ◽

Barbed Suture ◽

Wound Complications ◽

Minimally Invasive Surgical ◽

Invasive Surgical Approach ◽

Seromuscular Layer ◽

Transversus Abdominis Muscle

ABSTRACT The objective of this study was to describe the operative technique and outcome of a simplified laparoscopic gastropexy approach in dogs. Twenty-one dogs undergoing prophylactic laparoscopic gastropexy with a simple continuous barbed suture without incising the seromuscular layer of the stomach and transversus abdominis muscle were reviewed. In 20 cases, additional procedures were performed (18 ovariectomies and 2 prescrotal castrations); 1 dog had two prior episodes of gastric dilation without volvulus and underwent gastropexy with a prophylactic intent. The gastropexy procedure had a median duration of 33 min (range 19–43 min). V-Loc 180 absorbable and the V-Loc PBT nonabsorbable suturing devices were used in 8 and 13 dogs, respectively. Minor intraoperative complications occurred in four cases: broken suture (1), needle dislodgement (2), and folded needle (1). Minor complications included self-limiting wound complications (3), abdominal discomfort (2), vomiting (1), and inappetence (2). Postoperative abdominal ultrasound performed after a median of 8 mo (6–36 mo) confirmed permanent adhesion at the gastropexy site in all dogs. One dog developed a fistula (1 yr postoperatively) and another a granuloma (3 mo postoperatively), both at the gastropexy site. Prophylactic laparoscopic gastropexy may be performed with knotless unidirectional barbed suture without creating an incision on the abdominal wall and stomach.

Download Full-text