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Endoscopic onlay repair for ventral hernia and rectus abdominis diastasis repair: Why so many different names for the same procedure? A qualitative systematic review

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Abstract

Background

A subcutaneous endoscopic onlay repair for ventral hernia with an anterior plication of diastasis recti (DR) has been published under different names in different countries. The aim of this systematic review is to assess the safety and feasibility of different named techniques with the same surgical concept.

Methods

The PRISMA guidelines were followed during all stages of this systematic review. The MINORS score system was used to perform qualitative assessment of all studies included in this review. Recommendations were then summarized for the following pre-defined key items: protocol, research question, search strategy, study eligibility, data extraction, study designs, risk of bias, publication bias, heterogeneity, and statistical analysis.

Results

The systematic literature search found 2548 articles, 317 of which were duplicates and excluded from analysis. The titles and abstracts from the remaining 2231 articles were assessed. After careful evaluation, 2125 articles were determined to be unrelated to our study and subsequently excluded. The full text of the remaining 106 articles was thoroughly assessed. Case reports, editorials, letters to the editor, and general reviews were then excluded. A total of 13 articles were ultimately included for this review, describing a similar subcutaneous endoscopic approach for repair of concomitant ventral hernias and rectus diastasis defined under nine different named techniques on 716 patients. The number of patients in those studies varied from 10 to 201. The mean operative time varied from 68.5 to 195 min. The most common complication was seroma, followed by pain requiring intervention, hematoma, and surgical site infection.

Conclusions

There are a few technique variations described in different studies, but with no significant differences in outcomes. We, therefore, propose to unify these procedures under one term, ENDoscopic Onlay Repair (ENDOR). This technique has shown to be effective and safe, with seroma being the most common complication.

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Funding

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Authors and Affiliations

  1. Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Flavio Malcher

  2. Department of Surgery, Montefiore Medical Center, 1825 Eastchester Road, The Bronx, NY, 10461, USA

    Diego Laurentino Lima

  3. Pernambuco Health College, Recife, PE, Brazil

    Raquel Nogueira C L Lima

  4. Department of Surgery, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil

    Leandro Totti Cavazzola

  5. Positivo University, Curitiba, Brazil

    Christiano Claus

  6. Department of Surgery, Montefiore Medical Center, Bronx, NY, USA

    Caroline T. Dong & Prashanth Sreeramoju

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  1. Flavio Malcher
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  2. Diego Laurentino Lima
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  3. Raquel Nogueira C L Lima
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  4. Leandro Totti Cavazzola
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  5. Christiano Claus
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  6. Caroline T. Dong
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  7. Prashanth Sreeramoju
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Correspondence to Diego Laurentino Lima.

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Disclosures

Dr Cavazzola discloses consulting fees from Strattner and Medtronic, outside the submitted work. Dr Malcher discloses consulting fees from BD & Medtronic, outside the submitted work. Drs DL Lima, RNCL Lima, C Claus, CT Dong, and P Sreeramoju disclose no financial relationships with industry or conflicts of interest.

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Malcher, F., Lima, D.L., Lima, R.N. et al. Endoscopic onlay repair for ventral hernia and rectus abdominis diastasis repair: Why so many different names for the same procedure? A qualitative systematic review. Surg Endosc 35, 5414–5421 (2021). https://doi.org/10.1007/s00464-021-08560-5

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