Abstract
Purpose
Laparoscopic incisional hernioplasty (LIH) bridges the fascial gap between the rectus muscles with a posteriorly placed mesh, and is a low recurrence alternative to other reconstructions. It is unclear if this repair optimizes the function of the abdominal wall. We hypothesize that significant medialization of the fascial edges occurs in patients who undergo LIH.
Methods
Two hundred fifty-eight patients underwent LIH by a single surgeon between 2004 and 2012. 44 of these had pre- and postoperative CT scans that illustrated the gap between the rectus muscles. All 44 patients underwent LIH with polyester composite mesh, with suture and tack fixation. The distance between the fascial edges on the pre- and postoperative CT scans was compared. Percent medialization was calculated for each defect.
Results
Average fascial separation reduction was 0.8 cm (6.56–5.76 cm, 12.2 % medialization, p < 0.0001). 36 of 44 patients demonstrated a reduction in hernia defect width (81.8 %): these defects reduced 1.09 cm (6.47–5.38 cm, 16.9 % medialization, p < 0.0001). In defects wider than 5 cm, the width reduced by 0.94 cm (8.48–7.54 cm, n = 26, 10.6 % medialization, p = 0.004). The use of meshes ≥500 cm2 reduced the defect by 0.95 cm (8.42–7.47 cm, 11.23 % medialization, n = 22, p = 0.005).
Conclusions
Significant medialization of the rectus muscles is evident in most patients undergoing LIH. Although the rectus muscles are not ideally approximated, this may help improve the function of the anterior abdominal wall. Further technical refinements and material improvements may improve the reconstructive results of the LIH.
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Conflict of interest
KR declares consultancy outside submitted work, grant support outside the submitted work, patent pending outside the submitted work, and no other conflict of interest that directly relates to this study. All other authors declare no conflict of interest.
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Panait, L., Bell, R.L., Roberts, K.E. et al. Closing the gap: medialization of fascia with laparoscopic incisional hernia repair. Hernia 17, 597–601 (2013). https://doi.org/10.1007/s10029-013-1133-4
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DOI: https://doi.org/10.1007/s10029-013-1133-4