Laparoscopic Assisted Recti Diastasis Approximation (LARDA), Experience and Outcome of a Novel Technique

Eva Lourdes, Sujith Wijerathne, Jesse Hu, Wee Boon Tan, Davide Lomanto, Prof. Minimally Invasive Surgery Centre, Department of Surgery, National University Health System, Singapore

Introduction: Rectus diastasis is common in women post pregnancy and the indications for surgery are controversial. However, it is reasonable to repair it with an umbilical hernia concurrently. Many variations of abdominoplasty have been described but little has been published on the concurrent laparoscopic repair of recti diastasis and umbilical hernia. Here, we describe a novel laparoscopic technique for concurrent repair of both problems.

Methods: Under general anaesthesia, the patient is placed in the supine position. A 10 mm port is placed in the right flank via Hasson approach and a 5 mm port is placed on each side of the first port. Diagnostic laparoscopy is performed and then reduction of the hernia contents. Subsequently, pneumoperitoneum is reduced and the diastasis is plicated laparoscopically using a suture passer with transfacial sutures placed via stab incisions along one side of the diastasis and extra-corporeally tied. Reduction of the divertification is confirmed by manual pressure on the anterior abdominal wall. Then, the hernia defect is reinforced with mesh placement and anchored using transfascial sutures and absorbable tacks. Patients were discharged with abdominal binder for a period of 1 month following surgery.

Results: Eight patients underwent the repair over a 2 year period in a tertiary institution. They were all mothers with mean age of 37 years (n:31–50). The main presentation was an abdominal lump secondary to the umbilical hernia and rectus diastasis. The mean operation time was 90 minutes (n:80-105). One patient underwent single port repair. The median length of stay post-operatively was 2 days (n:1–3). All patients were followed up for minimum of 3 months. No complications of seroma or infection. All patients were satisfied with the cosmetic outcome.

Conclusion: Our technique of concurrent management of rectus diatasis and umbilical hernia laparoscopically is feasible and reproducible with good outcomes.