Caroline T Dong, MD, David M Pechman, MD, MBA, David Weithorn, MD, Prashanth V Sreeramoju, MD, MPH, FACS, Diego R Camacho, MD, FACS, Flavio Malcher Martins De Oliveira, MD, MSc. Montefiore Medical Center
BACKGROUND: Patients presenting for evaluation of umbilical hernias are often found to have concomitant diastasis recti. Isolated repair of hernia defects in these patients may not provide complete symptomatic relief and may also be associated with higher risk of recurrence. As diastasis recti is suggestive of additional underlying weakness of the anterior abdominal wall, these patients may require additional surgical techniques to improve the likelihood successful repair. Prior international publications have described a prefascial mesh repair in combination with anterior plication of diastasis. We present our initial US experience with a subcutaneous onlay laparoscopic approach (SCOLA) for mesh repair of umbilical hernia with concurrent plication of diastasis recti as a minimally-invasive alternative to both traditional open plication and an ergonomically favorable alternative to laparoscopic posterior plication.
METHODS: This is a prospective case series of 5 patients who underwent SCOLA technique for mesh repair of umbilical hernia with concurrent plication of diastasis recti. Subcutaneous dissection was carried out from a suprapubic incision superiorly to the xyphoid process and laterally to the linea semilunaris with two working ports placed in the bilateral lower quadrants. Midline defects were closed primarily with anterior plication of diastasis using running barbed suture. Polypropylene mesh was placed in an onlay fashion and secured with either running coronal or interrupted cardinal sutures, according to surgeon preference. Fibrin sealant was used both as an additional method of securing the mesh and as a means to reapproximate the subcutaneous space. At least one subcutaneous drain was placed. Cases were performed by three separate attendings with one attending supervising all cases to ensure appropriate technique.
RESULTS: All 5 patients were female. Mean age was 41.2 (27-58) years and mean BMI was 30.1 (25.5-36.3) kg/m2. Mean operative time was 173.6 (143-198) minutes with all cases performed as outpatient same-day procedures. One case was performed robotically with the longest operative time at 198 minutes. Mean defect size was 2.3 (1.5-3.0) cm with 4 (80%) patients having multiple defects repaired. At two-week follow-up no postoperative complications (seroma, hematoma, infection) were reported.
CONCLUSION: SCOLA technique is shown to be a safe and effective approach for patients presenting with umbilical hernia associated with concomitant diastasis recti, as prior international experience has demonstrated. Preliminary data shows zero early postoperative complication or hernia recurrence. Additional prospective data will allow future comparison of long-term outcomes compared to more established approaches such as traditional open or laparoscopic intraperitoneal onlay mesh (IPOM), particularly with regards to recurrence rates and patient satisfaction. Finally, further experience with robotics may have benefits compared to traditional laparoscopy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 98934
Program Number: ETP732
Presentation Session: Emerging Technology Poster Session (Non CME)
Presentation Type: Poster