Laparo-Endoscopic Repair of Ventral Hernia and Rectus Diastasis

Mini-invasive surgery for diastasis recti: an overview on different approaches

Diastasis recti abdominis (DRA) is an acquired condition defined by a widening of the linea alba exceeding 2 cm and the subsequent separation between the two medial margins of the rectus muscles, accompanied by a laxity of the ventral abdominal muscles, and often by ventral midline hernias. It is a quite common problem in women after pregnancy. In addition to the aesthetic implications resulting from the swelling of the anterior abdominal wall in the case of increased pressure within the abdominal cavity, DRA leads to several physical functional disorders, including muscle weakness, prolapses of the pelvic organs, urinary and fecal incontinence, low back and pelvic pain and sexual dysfunction. The management of diastasis recti can be conservative, with physiotherapy and specific physical exercises, but, especially in case of concomitant hernia, surgery can be considered as the first choice of treatment in order to restore the midline and repair the hernia. Through recent years, a large amount of mini-invasive surgical techniques has been proposed, approaching the abdominal differently, and to date there is still lack of evidence on the optimal choice for surgeons and patients. So, the present review aims to give the reader an overview on the different techniques proposed, focusing on the three main categories of approaches (pre-aponeurotic, retro-muscular and pre-peritoneal), their specific features and results, with a view on the newly proposed robotic approaches that can theoretically reproduce each single technique.

Laparoendoscopic extraperitoneal surgical techniques for ventral hernias and diastasis recti repair: a systematic review

PURPOSE

this systematic review aims to classify and summarize the characteristics and outcomes of the different laparoendoscopic extraperitoneal approaches for the repair of ventral hernias and diastasis recti described in the last 10 years.

METHODS

a literature search was performed by two reviewers in December 2023 including articles from January 2013, 01 to December 2023, 15. The techniques were selected according to the surgical access site (anterior or posterior to the rectus sheath), the access type (laparoendoscopic, single incision laparoscopic, mini or less open), the main space used to repair the defect (subcutaneous or retromuscular) and the mesh place (onlay, sublay-retromuscular or sublay-preperitoneal) and classified as anterior or posterior approaches.

RESULTS

the literature search retrieved 1755 results and 27 articles were included in the study. The studies included 1874 patients, the mean age ranged from 37.8 to 60.2 years. The access site was anterior in 16 cases and posterior in 11 cases. The mesh was positioned onlay in 13 cases and sublay in 13 cases, with only one study using no mesh. Complications were: seroma, ranging from 0.8 to 81%, followed by skin complications (leak, ischemia, necrosis) from 0.8 to 6.4%, surgical site infections and bleeding. Recurrences ranged from 0% to 12,5%, with a mean follow-up from 1 to 24 months.

CONCLUSION

this systematic review confirms the presence of several new minimally invasive extraperitoneal techniques for the repair of abdominal wall defects, with different advantages and disadvantages. Further studies, with more extensive follow-up data and wider patient groups, are necessary to define specific indications for each technique.

Laparo-Endoscopic Repair of Ventral Hernia and Rectus Diastasis

Background:

Both umbilical and epigastric hernias may be associated with rectus muscle divarication. In such cases, isolated repair of combined hernia defects can have high recurrence rates and poorer cosmetic outcomes, thus the repair of both pathologies ought to be favored. The goal of the study below is to provide detailed technical aspects of the endoscopic retro-rectus mesh repair.

Methods:

We chose a group of 16 patients who underwent the repair of ventral hernias associated with both primary and incisional rectus diastasis, using the extended-view of a totally extraperitoneal Rives-Stoppa repair (eRives) technique. All defects were < 6 cm in width. Our outcome measures perioperative complications and early recurrences.

Results:

The approach used in our study has led to zero cases of perioperative complications and only one early recurrence.

Conclusions:

We believe that the e-Rives repair is the optimal approach for ventral hernias associated with diastasis recti. This technique additionally produces favorable cosmetic outcomes that granted our results a well-deserved recognition in the medical literature.