Hira Ahmad, MD1, Jeremy Eckstein, MD2. 1Cleveland clinic Florida, 2Memorial Regional Hospital
Introduction: The incidence of ventral hernia can range from 2-30%. Laparoscopic ventral hernia repair has been well described in the literature. We aim to present a new technique of robotic repair of ventral hernia in concurrence with repair of diastasis recti with rectus abdominis mobilization. In addition, rectus abdominis mobilization has an added advantage of providing a tension free ventral hernia repair.
Objective: To determine the feasibility and safety of robotic repair of ventral hernia and repair of diastasis recti with rectus abdominis mobilization.
Methods: A 51 year old female presented to our clinic with an asymptomatic enlarging ventral hernia and troublesome diastasis recti. Her past medical history included hypothyroidism, anxiety, hyperlipidemia, and gastritis. She also had a surgical history of laparoscopic cholecystectomy, open hysterectomy and bilateral oophorectomy. The patient was a former 30 pack per day smoker. On physical exam, the patient had a midline ventral hernia, and significant diastasis recti. She was taken to the operating room for robotic repair. After initial dissection and resection of the hernia sac, we attempted a primary hernia repair with running #1 prolene V-lock stitches that broke twice during repair due to excessive tension. We then proceeded to undermine the fascia of rectus muscle bilaterally and completely separated it from the anterior fascia. After rectus muscle mobilization, primary repair of the ventral hernia was successful without tension with #1 prolene V-lock suture. The rectus muscle and its posterior fascia was reapproximated to the midline covering the defect in its entirety and fixing the diastasis recti. Ventralight ST with Echo PS mesh (4”x6”) was used to reinforce the repair using #1 prolene V-lock suture.
Results: Patient was admitted overnight post operatively for pain control. Patient was discharged home in stable condition on postoperative day one. She was followed up in the clinic two weeks later with no complaints.
Conclusions: Ventral hernia and diastasis recti repair can be successfully done robotically by mobilizing rectus abdominis muscle. Component separation has an added benefit of tension free repair with the potential to decrease recurrence.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88235
Program Number: V147
Presentation Session: Hernia Videos Session
Presentation Type: Video