Laparoscopically assisted components separation technique for ventral incisional hernia repair |
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Authors: | Meghan L Milburn Paulesh K Shah Erica B Friedman J Scott Roth Grant V Bochicchio Benjamin Gorbaty Ronald P Silverman |
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Institution: | (1) Department of Surgery, University of Maryland School of Medicine, Baltimore, MD, USA;(2) University of Maryland School of Medicine, Baltimore, MD, USA;(3) Department of General Surgery, University of Maryland School of Medicine, Baltimore, MD, USA;(4) R. Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA |
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Abstract: | Reconstruction of the abdominal wall to repair ventral hernias continues to pose a challenge to surgeons due to relatively
high rates of recurrence and morbidity. In 1990, Ramirez pioneered a technique of components separation of the abdominal wall
for ventral hernia repair. Although an effective hernia repair, the mobilization of skin and subcutaneous tissue endangers
the blood supply and predisposes midline skin to necrosis. The goal of this study is to determine whether releasing incisions
in the transversus abdominis fascia and posterior rectus sheath provide adequate mobilization of the abdominal wall necessary
for ventral hernia repair, thus paving the way for a laparoscopic component separation technique. Ten fresh cadavers were
used and one side of the abdomen underwent the conventional Ramirez components separation: midline incision, dissection of
skin and subcutaneous tissue off the anterior abdominal wall, and incisions in the external oblique aponeurosis and posterior
rectus sheath, while the other side received incisions in the transversus abdominis fascia and the posterior rectus sheath
with no undermining of the skin. The amount of fascial translation was measured after each incision. Incising only the external
oblique aponeurosis produced greater mobilization of the abdominal wall at the level of the umbilicus (P = 0.02) and anterior superior iliac spine (ASIS, P = 0.029) than releasing only transversus abdominis fascia. More importantly, there was no statistically significant difference
in the amount of release produced by the complete internal-release components separation versus the conventional technique.
In order to test the feasibility of performing the procedure laparoscopically, one additional cadaver underwent a laparoscopic
transversus abdominis fascia release. The procedure was successful and resulted in comparable amounts of fascial release as
the other 10 cadavers. From this study, it appears technically feasible to perform a laparoscopic components separation to
repair a ventral hernia and the procedure produces the same amount of release as the conventional open component separation
technique. |
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Keywords: | Ventral hernia repair Incisional hernia repair Laparoscopic hernia repair Component(s) separation technique |
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