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Severe rectus diastasis with midline hernia associated in males: high recurrence in mid-term follow-up of minimally invasive surgical technique

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Abstract

Propose

The present study aimed to assess clinical results, in terms of postoperative pain, functional recovery and recurrence rates of FESSA (Full Endoscopic Suprapubic Subcutaneous Access) technique compared to endoscopic anterior rectus sheaths plication and mesh, in male patients with midline ventral or incisional hernias and severe rectus diastasis (SRD) associated. Secondary aims were to identify intra- and postoperative complications associated with each technique.

Methods

Male patients with midline ventral or incisional hernia and severe rectus diastasis were included in a prospectively maintained databased and retrospectively analyzed from January 2017 to December 2020. From January 2017 to January 2019, male patients underwent to anterior rectus sheaths plication (ARSP) (Control group). From January 2019 to December 2020, male patients underwent to FESSA technique (FT) (Case group).

Results

53 patients were finally included. 28 patients (52%) underwent to FT and 25 patients (48%) to ARSP. Regarding intraoperative complications, no significant differences were identified between the groups. Hospital stay was significantly improved in FT group when compared to ARSP group. No significant differences in terms of postoperative seroma or hematomas, were shown. FT group showed significantly less pain on 1st, 7th and 30th postoperative days than ARSP group. Functional recovery was significantly improved in FT group compared to ARSP group on the 30th day and no differences were observed on the 180th day after surgery. The mean follow-up was 17.3 ± 2.6 months in FT group and 24 ± 3 months in ARSP group. During the follow-up, 1(3%) and 9 (36%) diastasis recurrences were identified respectively, with significant differences in favor of FT group.

Conclusion

In males with SRD and symptomatic midlines hernias, ARSP with onlay mesh placement shows high diastasis recurrence rate in mid-term follow-up. We propose FESSA technique in those patients, which decreases the excessive midline tension, improving the postoperative pain, functional recovery and recurrence rate, without increasing postoperative complications.

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Authors and Affiliations

  1. Minimally Invasive Gastrointestinal Surgery, General and Digestive Surgical Department, Virgen Macarena Hospital, Seville, Spain

    J. Bellido-Luque, J. C. Gomez-Rosado, I. Sanchez Matamoros, A. Nogales Muñoz & F. Oliva Mompeán

  2. Gastrointestinal Surgical Department, QuirónSalud Sagrado Corazón Hospital, Seville, Spain

    J. Bellido-Luque, A. Bellido-Luque & S. Morales Conde

Authors
  1. J. Bellido-Luque
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  2. J. C. Gomez-Rosado
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  3. A. Bellido-Luque
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  4. I. Sanchez Matamoros
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  5. A. Nogales Muñoz
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  6. F. Oliva Mompeán
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  7. S. Morales Conde
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Correspondence to J. Bellido-Luque.

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The authors have no conficts of interest to declare.

Ettical approval

The study was approved by the local ethics committees of participating hospital (virgen Macarena y virgen del Rocio, internal code 1262-N-21)

Consent to participate

This study was conducted according to the Declaration of Helsinki and the guidelines of Good Clinical Practique (World Medical Association, 2013), Written informed consent was obtained from patients, or relatives/next of kin of critically ill patients, prior to enrolment.

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All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Bellido-Luque, J., Gomez-Rosado, J.C., Bellido-Luque, A. et al. Severe rectus diastasis with midline hernia associated in males: high recurrence in mid-term follow-up of minimally invasive surgical technique. Hernia 27, 335–345 (2023). https://doi.org/10.1007/s10029-022-02706-7

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