Shirin Towfigh, MD1, Rachel Dbeis2. 1Beverly Hills Hernia Center, California, USA, 2University of Exeter Medical School, Exeter, UK
Introduction: Rectus diastasis is typically an asymptomatic but cosmetically displeasing condition that is not repaired electively except for cosmetic purposes. However, we have noticed that hernias that fall within a rectus diastasis tend to have a higher recurrence rate and poorer cosmetic outcome if the diastasis is not addressed at the same juncture. Diastasis closure can involve plication of the anterior rectus sheath via open abdominoplasty procedure or plication of the posterior rectus sheath via laparoscopic or robotic-assisted procedure.
Procedure: We present the case of a 53 year old male patient with an umbilical hernia within a 3 cm wide rectus diastasis. The patient underwent a primary umbilical hernia repair with closure of the rectus diastasis, performed with robotic assistance. We describe a minimally invasive technique which addresses the umbilical hernia and adds a plication of the posterior sheath via a three layer suture closure approach to correct the rectus diastasis and support the hernia repair. Three robotic trocars were used via left lateral abdominal approach.
The procedure was performed as an outpatient and only required oral anti-inflammatories for pain relief. At 2 weeks postoperative follow up, the patient showed excellent recovery, successful hernia repair with a nice innie umbilicus and 3 cm reduction in waistline.
Conclusion: The repair of a hernia within a rectus diastasis has an expected higher than average recurrence rate, as the hernia lays within the thinned weakened linea alba. If feasible, closure of the diastasis will help support the primary hernia repair and reduce the rate of hernia recurrence. This can be performed with robotic assistance with low morbidity and excellent cosmetic outcome. We recommend considering robotic-assisted hernia repair as usual, with or without mesh as needed followed by diastasis closure for optimal longer outcome and improved cosmesis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80587
Program Number: V119
Presentation Session: Hernia Video Session
Presentation Type: Video