RESUMEN
Objective: The objective of this study is analyze the outcomes of retro-muscular repair techniques for ventral hernias performed by a single surgeon in a renowned hernia surgery center. Method: This study involved 197 patients who underwent surgery between May 2016 and December 2021 under the care of a single surgeon (VR). Respecting the indication/contraindications of the eTEP procedure, 197 of 212 patients with ventral hernias underwent eTEP/eTEP-TAR surgery during this period. The cohort consisted of diverse hernia types, including median, lateral, and multiple-site defects. The safety of this approach was evaluated based on postoperative occurrences, where the number of complications accounted for 5% of the cases. Results of the study indicated that there was a significant improvement in the quality of life of patients following the procedure. The assessment, which measured postoperative pain, normal activity, and aesthetics on a 0-10 scale, showed improvement at 2 weeks and 3 months after surgery compared to the preoperative level. However, after a mean of 51.11 months, only one case of recurrence was reported. This recurrence occurred on top of the mesh, 18 months after the initial operation. The follow-up period lasted between 24 and 90 months. Patient monitoring was conducted either in person or over the phone, focusing on quality of life, postoperative pain, and the occurrence of recurrence. In conclusion, the laparo-endoscopic retro-muscular repair of ventral hernias, whether primary or incisional, has shown to yield excellent results in medium and long-term follow-up. The eTEP technique combines the benefits of the Rives-Stoppa technique (considered the gold standard in open ventral hernia repair) with the advantages of minimally invasive surgery.
RESUMEN
video width="640" height="480" controls controlsList="nodownload" poster="https://www.revistachirurgia.ro/pdfs/video/Diana_Teodora_Cucu-Abdominal_Wall_Reconstruction.jpg" style="margin-top: -20px;" source src="https://www.revistachirurgia.ro/pdfs/video/Diana_Teodora_Cucu-Abdominal_Wall_Reconstruction.mp4" type="video/mp4" Your browser does not support the video tag. /video Breast reconstruction with a pedicled transverse rectus abdominis muscle (TRAM) flap can result in significant abdominal wall donor-site morbidity. Although the pedicled TRAM flap donor area reinforced with mesh results in decreased rates of postoperative abdominal bulging and hernias, the best technique to accomplish that is yet to be elucidated. Antonio Espinosa de Los Monteros all. published recently a novel technique of posterior components separation with transversus abdominis muscle release and retro-muscular mesh reinforcement for donor-area closure during pedicled TRAM flap breast reconstruction (1). In this case we present this technique using the robotic technology. The robotic surgery allows a delicate dissection of the pre-peritoneal and pre-transversalis space, which represents a posterior component separation without transversus abdominis release (TAR). It is about a 40 y.o. lady, BMI 25 who underwent a radical mastectomy and TRAM flap breast reconstruction. She developed a complex incisional hernia, M2W1 and L3W2 on the left flank, considering the EHS classification (2). Our robotic approach is a minimally invasive surgery (MIS), enhanced view totally extraperitoneal (eTEP)(3) access technique which respects and follows the principles of the original open technique. The key-stages of the procedure are: 1. development of the retro-rectus space, using an optic trocar; 2. placement of the ports, medially to the linea semilunaris; 3. crossingover the midline; 4. dissection the contra-lateral pre-peritoneal/pre-transversalis space (without trans-section of the transversus abdominis muscle); 5. closure of the lateral defect and then, restoration of linea alba; 6. mesh placement. Combining the eTEP approach together with the posterior component separation (but avoiding TAR) and also with the benefits of the robotic surgery, this technique offers a fast recovery and excellent cosmetic results.
