Real-time Fluorescent Videoangiographic Evaluation Demonstrate Preservation of Vascular Supply During Total Endoscopic and Laparoscopic Component Separation

J Roberto Ramirez Gavidia, MD, Kalman Bencsath, MD, Matthew Kroh, MD, Bipan Chand, MD, Sricharan Chalikonda, MD. Cleveland Clinc Foundation


The endoscopic component separation (ECST) technique for hernia repair has been shown to decrease wound morbidity when compared to open component separation. This may in part be due to the preservation of blood supply that originates from the epigastric vessels. Laparoscopic ventral hernia repair has shown advantages over open ventral hernia repair in terms of mesh infection and recurrence. Real time videoagiographyis a new tool that has been utilized in plastic surgery to evaluate vascular supply to skin flaps for reconstructive purposes. We describe a novel technique of utilizing these modalities for treatment of a complex incisional hernia.
Our Patient underwent ECST in combination with laparoscopic primary closure of the linea Alba and reinforcement with underlay mesh. Skin flaps were evaluated pre- and post-procedure utilizing real time video angiography.
Our technique combines ECT with LVH repair with primary fascial closure and mesh reinforcement to truly develop a minimally invasive approach. The ECST allows advancement of the myofascial complex which in turn decreases tension in the midline allowing laparoscopic re-approximation of the rectus muscles in the midline rectus; reapproximation for hernia repair improves functionality of the abdominal wall. After evaluating the blood supply to the flap pre-operatively, video angiography allowed us to confirm that vascularity is preserved by performing ECST,
ECST in combination with LVH with primary fascial closure and mesh reinforcement is feasible and takes the advantages of both techniques. The preservation of vascular supply to the flaps and the decrease in the incision hypothetically reduces the rate of associated wound complications compared to open CST. A prospective, randomized study will be needed to accurately describe potential benefits of this technique.

Session Number: VidTV1 – Video Channel Rotation Day 1
Program Number: V076

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