Richard Lu, MD1, Alex Addo, MD1, Allison Estep, MD2, Reza Zahiri, DO1, Igor Belyansky, MD, FACS1. 1Anne Arundel Medical Center, 2MedStar Health Baltimore
INTRODUCTION: Minimally invasive retromuscular abdominal wall reconstruction is a relatively novel approach. As this technique becomes more widespread, it is crucial to consider its complications, particularly those that are unique to these operations. We present our institution’s complications with this approach.
METHODS: A review of our center’s prospectively maintained database of hernia patients was conducted. This identified 435 patient who had undergone laparoscopic or robotic Rives-Stoppa and transversus abdominis release reconstructive procedures between August 2015 to August 2018.
RESULTS: Mean follow-up was 7.9 months (range, 1-31 months). The overall complication rate was 9% (N=41) with the most common being postoperative seromas (3%, N=15). Four of these were retromuscular, the remaining were subcutaneous. The majority of these required interventions with either aspiration in clinic or placement of a percutaneous drain for retromuscular seromas. Three subfascial seromas became infected which were explored and drained endoscopically. Subfascial hematomas were seen in 1% of patients (N=3) with one requiring endoscopic drainage. A unique but devastating complication of retrorectus hernia repairs is the failure of the posterior rectus sheath which required urgent reoperation due to exposure of bowel to mesh. This occurrence was seen in 3 patients. Two patients had injuries to the linea alba which were not identified at the time of the original surgery. This resulted in destabilization of the abdominal wall and early recurrences requiring emergent intervention. The overall recurrence rate was 1% (N=5). Postoperative ileus and small bowel obstruction were observed in 2% of patients (N=6) and managed nonoperatively. Venous thromboembolism disease (VTE) and cardiopulmonary events were observed in 1% of patients (N=6). There was one mortality in the early perioperative period due to a fatal pulmonary embolus.
CONCLUSIONS: In the recent past several novel MIS reconstructive abdominal techniques have been described by our group. As other surgeons begin to adopt some of these more complex approaches, it is critical to consider the unique complications and be prepared to implement potential management strategies. While the overall complication rates are low in our high-volume center, it is not clear if these results are reproducible by other hernia centers. Furthermore, additional efforts should be made to determine overall complication rates in low-volume centers.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95645
Program Number: P544
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster