An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis Muscle
Purpose: We present our algorithmic approach for symptomatic ventral hernias with Diastasis of the Rectus Abdominis Muscle (DRAM).Methods: Retrospective analysis of patients with symptomatic ventral hernias and DRAM undergoing hernia repair and plication of DRAM from July 2018–March 2021 was conduct...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-12-01
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| Series: | Journal of Abdominal Wall Surgery |
| Subjects: | |
| Online Access: | https://www.frontierspartnerships.org/articles/10.3389/jaws.2022.10864/full |
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| author | Cosman Camilo Mandujano Diego L. Lima Jason Xia Prashanth Sreeramoju Flavio Malcher |
| author_facet | Cosman Camilo Mandujano Diego L. Lima Jason Xia Prashanth Sreeramoju Flavio Malcher |
| author_sort | Cosman Camilo Mandujano |
| collection | DOAJ |
| description | Purpose: We present our algorithmic approach for symptomatic ventral hernias with Diastasis of the Rectus Abdominis Muscle (DRAM).Methods: Retrospective analysis of patients with symptomatic ventral hernias and DRAM undergoing hernia repair and plication of DRAM from July 2018–March 2021 was conducted. Based on our algorithm, patients were selected for an Endoscopic Onlay Repair (ENDOR) or a Robotic Extended Totally Extraperitoneal Ventral Repair (R-eTEP).Results: We performed a R-eTEP in fifty-seven patients and an ENDOR in twenty-four patients. In the R-eTEP group, thirty-seven (65%) patients were female, the mean age was 54.8 (±10.6), and the mean BMI was 32 (±4.8). Fifty patients (87.7%) had multiple defects, of which 19 (38%) were recurrent hernias and 31 (62%) were incisional hernias. The mean operative time was 200 (±62.4) minutes, with two cases requiring a hybrid approach. The median length of stay was 1 day (0–12), and the median follow-up was 103 days. Twenty-four patients underwent an ENDOR, 19 females (79.2%), the mean age was 45.7 years (±11.7) and the mean BMI was 28 (±3.6). 13 patients had isolated umbilical or epigastric hernias. The mean operative time was 146.2 min (±51.1). Fibrin sealant and suture was the predominant method for mesh fixation, and most cases were performed in an ambulatory setting. Four patients developed post-operative seromas; one requiring drainage due to infection. The Median follow-up was 48.5 days (10–523), with two reported hernia recurrences.Conclusion: An algorithmic approach for adequate patient selection was shown to be safe for treating ventral hernias with DRAM. |
| first_indexed | 2024-04-10T05:56:35Z |
| format | Article |
| id | doaj.art-cc95d36536f34a2ca3eca61673cfbfb8 |
| institution | Directory Open Access Journal |
| issn | 2813-2092 |
| language | English |
| last_indexed | 2024-04-10T05:56:35Z |
| publishDate | 2022-12-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Journal of Abdominal Wall Surgery |
| spelling | doaj.art-cc95d36536f34a2ca3eca61673cfbfb82023-03-03T12:44:15ZengFrontiers Media S.A.Journal of Abdominal Wall Surgery2813-20922022-12-01110.3389/jaws.2022.1086410864An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis MuscleCosman Camilo Mandujano0Diego L. Lima1Jason Xia2Prashanth Sreeramoju3Flavio Malcher4Department of Surgery, Montefiore Medical Center, Bronx, NY, United StatesDepartment of Surgery, Montefiore Medical Center, Bronx, NY, United StatesDepartment of Surgery, Montefiore Medical Center, Bronx, NY, United StatesDepartment of Surgery, Montefiore Medical Center, Bronx, NY, United StatesAbdominal Wall Reconstruction Program, Department of Surgery, Montefiore Medical Center, Bronx, NY, United StatesPurpose: We present our algorithmic approach for symptomatic ventral hernias with Diastasis of the Rectus Abdominis Muscle (DRAM).Methods: Retrospective analysis of patients with symptomatic ventral hernias and DRAM undergoing hernia repair and plication of DRAM from July 2018–March 2021 was conducted. Based on our algorithm, patients were selected for an Endoscopic Onlay Repair (ENDOR) or a Robotic Extended Totally Extraperitoneal Ventral Repair (R-eTEP).Results: We performed a R-eTEP in fifty-seven patients and an ENDOR in twenty-four patients. In the R-eTEP group, thirty-seven (65%) patients were female, the mean age was 54.8 (±10.6), and the mean BMI was 32 (±4.8). Fifty patients (87.7%) had multiple defects, of which 19 (38%) were recurrent hernias and 31 (62%) were incisional hernias. The mean operative time was 200 (±62.4) minutes, with two cases requiring a hybrid approach. The median length of stay was 1 day (0–12), and the median follow-up was 103 days. Twenty-four patients underwent an ENDOR, 19 females (79.2%), the mean age was 45.7 years (±11.7) and the mean BMI was 28 (±3.6). 13 patients had isolated umbilical or epigastric hernias. The mean operative time was 146.2 min (±51.1). Fibrin sealant and suture was the predominant method for mesh fixation, and most cases were performed in an ambulatory setting. Four patients developed post-operative seromas; one requiring drainage due to infection. The Median follow-up was 48.5 days (10–523), with two reported hernia recurrences.Conclusion: An algorithmic approach for adequate patient selection was shown to be safe for treating ventral hernias with DRAM.https://www.frontierspartnerships.org/articles/10.3389/jaws.2022.10864/fullrobotic abdominal wall repairventral hernia repairlaparoscopic ventral hernia repairminimally invasivediastasis of the rectus abdominis muscle |
| spellingShingle | Cosman Camilo Mandujano Diego L. Lima Jason Xia Prashanth Sreeramoju Flavio Malcher An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis Muscle Journal of Abdominal Wall Surgery robotic abdominal wall repair ventral hernia repair laparoscopic ventral hernia repair minimally invasive diastasis of the rectus abdominis muscle |
| title | An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis Muscle |
| title_full | An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis Muscle |
| title_fullStr | An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis Muscle |
| title_full_unstemmed | An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis Muscle |
| title_short | An Algorithmic Approach for the MIS Repair of Ventral Midline Hernias Associated With Diastasis of the Rectus Abdominis Muscle |
| title_sort | algorithmic approach for the mis repair of ventral midline hernias associated with diastasis of the rectus abdominis muscle |
| topic | robotic abdominal wall repair ventral hernia repair laparoscopic ventral hernia repair minimally invasive diastasis of the rectus abdominis muscle |
| url | https://www.frontierspartnerships.org/articles/10.3389/jaws.2022.10864/full |
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