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Total endoscopic-assisted linea alba reconstruction (TESLAR) for treatment of umbilical/paraumbilical hernia and rectus abdominus diastasis is associated with unacceptable persistent seroma formation: a single centre experience

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Abstract

Purpose

Umbilical hernia with concomitant rectus abdominus diastasis (RAD) is potentially associated with higher recurrence. Open and laparoscopic techniques have already been described, however, recent endoscopic methods show great promise. Therefore, our aim was to establish the risks and benefits of performing total endoscopic-assisted linea alba reconstruction (TESLAR).

Methods

A retrospective review from 28/03/2018 to 01/05/2019 of TESLAR patients was undertaken. Data collected included medical history, operative notes and postoperative course. Statistical analyses were performed using univariate analysis. Operative technique began with a subcutaneous dissection from the lateral borders of anterior rectus sheath, lower costal margin, and pubic bone. The defect was defined and subsequently reduced. Anterior rectus sheath was subsequently plicated and if a mesh was inserted, an on-lay mesh was placed.

Results

21 patients were identified with an 8:13 male to female ratio. Mean age and BMI were 53.1 and 29.7, respectively. 19/21 patients reported post-operative complications requiring reintervention. 17/21 patients had a seroma, all requiring draining with a minority (5/21) requiring formal excision. Univariate analysis showed age (p < 0.001), BMI (p < 0.001) and female gender (p = 0.022) were significantly associated with repeated number of seroma aspirations.

Conclusion

TESLAR is associated with high rates of seroma and reintervention, including revisional surgery. Open repair should be considered as an alternative strategy for hernia and RAD repair.

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Funding

The authors confirm that no external funding was received for this study.

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Authors and Affiliations

  1. Department of General Surgery, Royal Lancaster Infirmary, University of Morecambe Bay Hospitals NHS Trust, Lancaster, UK

    Aaron Kler & Paul Wilson

Authors
  1. Aaron Kler
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  2. Paul Wilson
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Contributions

PW contributed to the study conception and design. Material preparation, data collection and analysis were performed by AK. The first draft of the manuscript was written by AK. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Aaron Kler.

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Conflict of interest

Aaron Kler and Paul Wilson declare that they have no conflicts of interests or competing interests.

Ethical approval

Ethical approval was waived following an ethics screen deemed that NHS Research Ethics Committee approval was not required by the NHS Health Research Authority.

Human and animal rights

The study was performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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Informed verbal consent was obtained for participants to use data in this study.

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Informed verbal consent was obtained for participants to use data to be published.

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Kler, A., Wilson, P. Total endoscopic-assisted linea alba reconstruction (TESLAR) for treatment of umbilical/paraumbilical hernia and rectus abdominus diastasis is associated with unacceptable persistent seroma formation: a single centre experience. Hernia 24, 1379–1385 (2020). https://doi.org/10.1007/s10029-020-02266-8

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  • DOI: https://doi.org/10.1007/s10029-020-02266-8

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