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The T-line hernia mesh is a synthetic, polypropylene mesh with mesh suture extensions designed to prevent anchor point failure by evenly distributing tension across the soft tissue. Previous studies have demonstrated the success of onlay ventral hernia repair with T-line hernia mesh, but retrorectus applications of the mesh have not yet been characterized. This technique article illustrates technical descriptions and clinical applications of the T-line hernia mesh in the retrorectus plane.
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BACKGROUND: Surgical clips are commonly used during laparoscopic cholecystectomy for cystic duct and artery ligation. Titanium and polymer clips are the two most common types used for this indication. Given the cost-saving potential, design advantages, and decreased incidence of complications associated with polymer clips, we sought to study whether there is a clinically significant difference in outcome between polymer and titanium clips in laparoscopic cholecystectomy. METHODS: Fifty consecutive cases using polymer clips followed by 50 consecutive cases using metal clips over a 6-month period by residents under the direction of a single surgeon were retrospectively reviewed. The following outcomes were evaluated: incidence of bile leak, postoperative bleeding, need for additional procedures, hospital length of stay, and cost. RESULTS: We found that significantly more misfires occurred with the use of the polymer clips (n=17) than with the titanium clips (n=2, p<.001). Eight cases (16%) required opening of an additional polymer clip cartridge to complete the operation. Despite this additional expense, the total cost as it pertained to clip usage ($30.32 USD) was still lower than that using titanium clips ($139.17 USD). While these numbers were not statistically significant, three cases had bile leaks and required additional procedures, all of which were performed with metal clips. No postoperative bleeds were identified and there was no difference in hospital length of stay; most patients were discharged on the day of the procedure. CONCLUSION: These findings demonstrate comparable clinical outcomes between laparoscopic cholecystectomies performed with polymer and titanium clips, though polymer clip usage carries a lower cost.
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INTRODUCTION: Rectus diastases (RD) are caused by a weakening of the abdominal musculature and a widening of the linea alba. Some patients are often erroneously told that they are hernias. Despite the fact that they are not true hernias, they are often associated with true hernias and undergo concomitant repairs. Robotic plication of these diastases has been gaining more widespread use in the past few years, but literature regarding outcomes remains limited. MATERIAL AND METHODS: All patients with RD and concomitant ventral hernia that underwent robotic repair were assessed from 2016 to present. Demographics, perioperative morbidity, and outcomes were reviewed, and descriptive analyses were performed. RESULTS: This series consists of 14 patients with an average age of 50.7 years (range 33-78 years), 64% female, and 86% Caucasian. All patients had associated umbilical or ventral/incisional hernia with an average defect size of 7.1cm2 and average mesh size of 254cm2. Robotic transabdominal pre-peritoneal (RTAPP) repair was performed in 67% of cases and robotic extended total extraperitoneal (ReTEP) repair was performed in 33%. Two patients (17%) required conversion to open repair. Hospital length of stay was 0.7 days. There was no morbidity in these patients. At an average follow-up of 2.6 years (range 54-2122 days), the hernia/diastasis recurrence rate is 7.1%. CONCLUSION: The results of this study suggest that robotic plication with intraperitoneal sublay mesh could be an acceptable surgical approach for RD associated with concomitant ventral hernia repair. Further investigation is required to assess outcomes in a larger group of patients and to determine long-term recurrence and complication rates.