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Changes in the lateral abdominal wall following endoscopic subcutaneous anterior component separation

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Abstract

Purpose

Although changes in lateral abdominal wall musculature after posterior component separation with transversus abdominis release have been investigated, the effects of endoscopic subcutaneous anterior component separation (ES-ACS) on postoperative muscle anatomy have not been evaluated. The purpose of this study was to evaluate changes in the lateral abdominal muscles after ES-ACS.

Methods

Computed tomography (CT) images of patients who underwent ES-ACS were retrospectively evaluated. Lateral abdominal wall thickness and external oblique displacement were measured at the level of fixed retroperitoneal structures. Measurements on the ES-ACS side were compared with those on the contralateral undivided side or with preoperative images in patients with bilateral procedures.

Results

Fifteen patients met the criteria for study inclusion. Most patients (n = 13, 86.7%) underwent unilateral ES-ACS. The most commonly performed procedure was laparoscopic intraperitoneal onlay mesh-plus hernia repair (n = 12, 80.0%; the remaining patients underwent open repair). The Mean defect width was 8.4 cm (range 6–15 cm). There was no difference in the thickness of the lateral abdominal musculature between ES-ACS and undivided sides. There was a significant lateral displacement of the external oblique muscle from the lateral edge of the rectus abdominis on the ES-ACS side (mean distance 3.7 cm; p = 0.0006). No midline hernia recurrences, iatrogenic linea semilunaris hernias, or lateral eventrations were observed during a mean follow-up period of 2.6 years (range 0.5–7.4 years).

Conclusion

ES-ACS resulted in no atrophy of the lateral abdominal muscles in long-term CT follow-up. The procedure is a safe and effective adjunct to complex hernia repair in selected patients.

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Acknowledgments

We thank Rebecca Tollefson, DVM, from Edanz Group (https://en-author-services.edanzgroup.com/) for editing a draft of this manuscript and Sabbagh Radiólogos for collaborating in the retrieval and analysis of CT images.

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Authors and Affiliations

  1. Department of Minimally Invasive Surgery, Clinica Portoazul, 30 Carrera, Corredor Universitario #1-850, Consultorio 411, Barranquilla, Colombia

    J. Daes

  2. Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA

    D. Morrell & E. M. Pauli

Authors
  1. J. Daes
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  2. D. Morrell
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  3. E. M. Pauli
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Correspondence to J. Daes.

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The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

IRB approval was waived due to the retrospective nature of the study.

Human and animal rights

The research did not involve human participants. Animals did not participate in the study. Only non-identifiable material was used in the present study.

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Daes, J., Morrell, D. & Pauli, E.M. Changes in the lateral abdominal wall following endoscopic subcutaneous anterior component separation. Hernia 25, 85–90 (2021). https://doi.org/10.1007/s10029-020-02303-6

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  • DOI: https://doi.org/10.1007/s10029-020-02303-6

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