Endoscopic transversus abdominis release separation in the treatment of patients with midline incisional hernias

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Abstract

Abstract. The issues of reconstruction of the anterior abdominal wall in patients with median postoperative ventral hernias remain relevant for many years. The paradigm of their treatment is gradually shifting towards functional minimally invasive reconstructions of the anterior abdominal wall. The indications and technical aspects of endoscopic posterior separation surgery are considered. The analysis of 70 transversus abdominis release was carried out. The average age of patients with postoperative ventral hernias was 61,2±10 years. The median follow-up was 14,2±8,2 months and the anaesthesia risk was 2,8±0,5. The mean hernia width was 151,7±73,7 cm2 and the implant size was 832,9±243,3 cm2. In the early postoperative period complications were observed in 7 (10%) patients, including the one with retromuscular hematoma, four with retromuscular space infection and two with superficial vein thrombophlebitis. Late complications were observed in 6 (8,7%) patients, there were persistent seroma (3) and chronic pain (3). No hernia recurrence was detected during this period. Thus, the use of endoscopic abdominal wall separation reduces the risk of local complications compared to similar open surgery. At the same time, there is a low level of hernia recurrence and a satisfactory quality of life. In total there were 70 (100%) transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal transversus abdominis release operations performed, among them 14 (77,8%) were bilateral transversus abdominis release and 32 (61,5%) were unilateral transversus abdominis release – 4 (22,2%) and 20 (38,4%) respectively were transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal – 10 (14,3%) operations with combined access were performed: 3 (16,7%) and 7 (1,5%) respectively transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal transversus abdominis release. In 13 (18,6%) cases simultaneous operations occurred, including 7 (10%) laparoscopic cholecystectomy and 6 (8,6%) endoscopic inguinal hernioplasty.

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About the authors

V. A. Burdakov

Voskresensk regional hospital number 2

Email: n.l.matveev@gmail.com
Russian Federation, Voskresensk

A. A. Zverev

Voskresensk regional hospital number 2

Email: n.l.matveev@gmail.com
Russian Federation, Voskresensk

S. A. Makarov

City Hospital of St. George the Great Martyr

Email: n.l.matveev@gmail.com
Russian Federation, Saint Petersburg

V. V. Strizheletsky

City Hospital of St. George the Great Martyr

Email: n.l.matveev@gmail.com
Russian Federation, Saint Petersburg

G. M. Rutenburg

City Hospital of St. George the Great Martyr

Email: n.l.matveev@gmail.com
Russian Federation, Saint Petersburg

N. L. Matveev

The Russian National Research Medical University named after N.I. Pirogov

Author for correspondence.
Email: n.l.matveev@gmail.com
Russian Federation, Moscow

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Supplementary files

Supplementary Files
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1. Location and size of hernias according to the EHS classification

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2. Fig. 1. Sectors of the anterior abdominal wall

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3. Fig. 2. Work in sector A. Location of ports and direction of dissection

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4. Fig. 3. Sector B. Location of ports and direction of dissection

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5. Fig. 4. Sector C. Location of ports and direction of dissection

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6. Fig. 5. Sector D. Location of ports and direction of dissection

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Copyright (c) 2020 Burdakov V.A., Zverev A.A., Makarov S.A., Strizheletsky V.V., Rutenburg G.M., Matveev N.L.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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