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Differences in midline fascial forces exist following laparoscopic and open transversus abdominis release in a porcine model

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Abstract

Introduction

Posterior component separation herniorrhaphy via transversus abdominis release (TAR) permits midline reapproximation of large fascial defects. To date, no report delineates the reduction in tensile force to reapproximate midline fascia following TAR. We hypothesized that open and laparoscopic TAR would provide similar reductions in midline reapproximation forces in a porcine model.

Methods

Under general anesthesia, a 20-cm midline laparotomy was created and bilateral lipocutaneous flaps were raised to expose the anterior rectus sheath. Five stainless steel hooks were placed at 1-cm intervals lateral to the midline at three locations: 5 cm above, at, and 5 cm below the umbilicus bilaterally. Baseline force measurements were taken by pulling each lateral point to midline. Laparoscopic TAR was performed unilaterally by incising the parietal peritoneum and transversus muscle lateral to the linea semilunaris. Open TAR was performed contralaterally, and force measurements were repeated. Comparisons were made to baseline and between the groups.

Results

Following laparoscopic TAR, 87 % (13/15) of points showed significant reduction compared to baseline forces, whereas only 20 % (3/15) of open TAR points had significant force reductions. Compared to open TAR, three locations favored the laparoscopic approach [1 cm lateral to midline, 5 cm above the umbilicus (p = 0.04; 95 % CI 0.78–1.00), 2 cm lateral to midline at the umbilicus (p = 0.04; 95 % CI 0.80–1.00), and 1 cm lateral to midline 5 cm below the umbilicus (p = 0.05; 95 % CI 0.79–1.00)]. The mean length of TAR was longer for laparoscopic than open at 27.29 versus 19.55 cm (p < 0.0001; 95 % CI 6.46–9.02).

Conclusions

Open TAR reduced midline tensile force at few locations, suggesting that the mechanism by which TAR facilitates herniorraphy may not solely be through reductions in linea alba tensile forces. At specific locations, laparoscopic TAR provides superior reduction in midline closure force compared to open TAR, likely as a result of a longer muscle release.

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Funding

Funding for this study was provided by Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) research award.

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Authors and Affiliations

  1. Division of Minimally Invasive Surgery, Department of Surgery, College of Medicine, The Pennsylvania State University, 500 University Drive, Hershey, PA, 17033-0850, USA

    Joshua S. Winder, Jerome Lyn-Sue & Eric M. Pauli

  2. Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA, USA

    Allen R. Kunselman

Authors
  1. Joshua S. Winder
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  2. Jerome Lyn-Sue
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  3. Allen R. Kunselman
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  4. Eric M. Pauli
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Correspondence to Eric M. Pauli.

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Disclosures

Joshua S. Winder, Jerome Lyn-Sue, Allen R. Kunselman have no conflicts of interest financial affiliations to disclose. Eric M. Pauli receives honoraria for teaching from Cook Biotech and Gore and clinical trial support from Cook and Micromatrix.

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Winder, J.S., Lyn-Sue, J., Kunselman, A.R. et al. Differences in midline fascial forces exist following laparoscopic and open transversus abdominis release in a porcine model. Surg Endosc 31, 829–836 (2017). https://doi.org/10.1007/s00464-016-5040-5

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  • DOI: https://doi.org/10.1007/s00464-016-5040-5

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