Abstract
Background
The eTEP Rives-Stoppa (RS) procedure, increasingly used for ventral hernia repair, has raised concerns about postoperative upper abdominal bulging. This study aims to objectively evaluate changes in the abdominal contour after eTEP RS and explore potential causes using a novel analytical tool, the Ellipse 9.
Methods
Thirty patients undergoing eTEP RS without posterior rectus sheath closure were assessed before and 3 months after surgery using CT scan images. Key measurements analyzed included the distance between linea semilunaris (X2), eccentricity over the Cord (c/a Cord), superior eccentricity (c/a Sup), Y2, and the superior perimeter of the abdomen. The Ellipse 9 tool, which provides graphical images and numerical representations, was utilized alongside patient-reported outcomes to assess perceived abdominal changes.
Results
The study group exhibited a trend toward a flatter abdomen with reduced distance between linea semilunaris(X2). However, 17% of patients developed upper abdominal bulging (5). Significant differences in c/a Cord, c/a Sup, Y2, and the superior perimeter of the abdomen, confirmed with Bonferroni corrections, were noted between bulging (5 patients) and non-bulging groups (25 patients). There was a notable disparity between patient perceptions and objective outcomes.
Conclusion
The eTEP RS procedure improved abdominal contour in most patients from a selected cohort. The Ellipse 9 tool was valuable for the objective analysis of these changes. The cause of bulging post-eTEP RS is probably multifactorial. Notably, there was often a discrepancy between patient perceptions of bulging and objective clinical findings.
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References
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Acknowledgements
We extend our heartfelt gratitude to Engineer Alberto Pedroza for his invaluable assistance in refining the Ellipse Tool. His expertise and dedication were instrumental in enhancing the tool’s functionality and precision, significantly contributing to the success of this project
Funding
This research received no specific grant from the public, commercial, or not-for-profit funding agencies.
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Jorge Daes conceived and designed the research, analyzed the data, and wrote the manuscript. Elika Luque helped design the study and contributed data. Andres Hanssen helped design the study and contributed data. Jose Rocha collected, organized, and performed statistical analysis and archived data.
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Jorge Daes, Elika Luque, Andres Hanssen, and Jose Rocha have no conflict of interest or financial ties to disclose.
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Daes, J., Luque, E., Hanssen, A. et al. eTEP Rives-Stoppa impact on abdominal contour: a retrospective observational and clinical quality improvement study using Ellipse 9 tool. Surg Endosc 38, 2197–2204 (2024). https://doi.org/10.1007/s00464-024-10767-1
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DOI: https://doi.org/10.1007/s00464-024-10767-1