Martin Galvarini, Maria Elena Peña, Jose Alvarez Gallesio, Francisco Schlottmann, Emmanuel Ezequiel Sadava. Hospital aleman de buenos aires
BACKGROUND: The presence of midline abdominal hernias associated with diastasis of the rectus abdominis muscles (DRA) leads to the treatment of both conditions in order to decrease recurrence rate. However, there is little evidence of laparoscopic approach for the combined repair of these parietal defects.
OBJECTIVE: To describe feasibility and results of laparoscopic abdominoplasty with mesh reinforcement for midline hernia combined with DRA.
MATERIALS AND METHODS: A retrospective review of consecutive patients underwent laparoscopic abdominoplasty with mesh reinforcement (parietal defect treatment and rectus abdominis plication) between January 2014 and March 2016 was performed. Patients with DRA but without hernia and those with less of 6 months of follow up were excluded. Demographic variables, surgical time, hospital stay, morbidity and mortality were analyzed. Postoperative pain (PP) was assessed with visual analogue scale (VAS) at 7 days, 1 month and at 6 months after surgery. The esthetic result, degree of satisfaction and time frame for the return to normal and sports activities were also evaluated.
RESULTS: Ten patients were included, 8 (80%) were women. Average age was 49 (37-70) years. Average body mass index was: 23.4 +/- 3.2 kg/m2. The average interrectal distance was: 5.3 (4-6) cm. Ninety percent had supra- and infra-umbilical DRA and 90 % referred pain at diagnosis. In all cases laparoscopic abdominoplasty was performed with continuous intracorporeal sutures with extracorporeal knot tying and intraperitoneal mesh reinforcement. The midline defects were: 4 umbilical hernias, 2 epigastric hernias, and 4 umbilical incisional hernias. The mean operative time was 110 (90-135) minutes. Hospital stay was 1 day for all cases. No postoperative complications were recorded. With an average follow-up of 15 (6-24) months, no recurrences were detected. At postoperative day 7, PP was 8 in 70% of patients, while no patient reported pain (PP = 0) at 1 and 6 postoperative month evaluation (p <0.05). Ninety percent of patients were very satisfied with the results. The median time of return to normal activities was 19 (7-30) days and 10 weeks (8-16) for full physical activity.
CONCLUSIONS: Laparoscopic mesh abdominoplasty is a feasible and safe procedure. A minimally invasive approach for this group of patients would be a valid alternative with very good esthetic and overall results.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80524
Program Number: P049
Presentation Session: Poster (Non CME)
Presentation Type: Poster