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. 2021 Feb;25(1):85-90.
doi: 10.1007/s10029-020-02303-6. Epub 2020 Sep 10.

Changes in the lateral abdominal wall following endoscopic subcutaneous anterior component separation

J Daes  1 , D Morrell  2 , E M Pauli  2
Affiliations

Changes in the lateral abdominal wall following endoscopic subcutaneous anterior component separation

J Daes et al. Hernia. 2021 Feb.

Abstract

Purpose: Although changes in lateral abdominal wall musculature after posterior component separation with transversus abdominis release have been investigated, the effects of endoscopic subcutaneous anterior component separation (ES-ACS) on postoperative muscle anatomy have not been evaluated. The purpose of this study was to evaluate changes in the lateral abdominal muscles after ES-ACS.

Methods: Computed tomography (CT) images of patients who underwent ES-ACS were retrospectively evaluated. Lateral abdominal wall thickness and external oblique displacement were measured at the level of fixed retroperitoneal structures. Measurements on the ES-ACS side were compared with those on the contralateral undivided side or with preoperative images in patients with bilateral procedures.

Results: Fifteen patients met the criteria for study inclusion. Most patients (n = 13, 86.7%) underwent unilateral ES-ACS. The most commonly performed procedure was laparoscopic intraperitoneal onlay mesh-plus hernia repair (n = 12, 80.0%; the remaining patients underwent open repair). The Mean defect width was 8.4 cm (range 6-15 cm). There was no difference in the thickness of the lateral abdominal musculature between ES-ACS and undivided sides. There was a significant lateral displacement of the external oblique muscle from the lateral edge of the rectus abdominis on the ES-ACS side (mean distance 3.7 cm; p = 0.0006). No midline hernia recurrences, iatrogenic linea semilunaris hernias, or lateral eventrations were observed during a mean follow-up period of 2.6 years (range 0.5-7.4 years).

Conclusion: ES-ACS resulted in no atrophy of the lateral abdominal muscles in long-term CT follow-up. The procedure is a safe and effective adjunct to complex hernia repair in selected patients.

Keywords: Abdominal muscle measurement; Compensatory hypertrophy; Computed tomography; Endoscopic subcutaneous anterior component separation; Myofascial release; Ventral hernia repair.

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References

    1. Daes J, Telem D (2019) The principled approach to ventral hernia repair. Rev Colomb Cir 34:25–28 - DOI
    1. Pauli EM, Rosen MJ (2013) Open ventral hernia repair with component separation. Surg Clin North Am 93:1111–1133 - DOI
    1. Winder JS, Behar BJ, Juza RM, Potochny PEM (2016) Transversus abdominis release for abdominal wall reconstruction: early experience with a novel technique. J Am Coll Surg 223(2):271–278 - DOI
    1. Novitsky YW, Fayezizadeh M, Majumder A, Neupane R, Elliott HL, Orenstein SB (2016) Outcomes of posterior component separation with transversus abdominis muscle release and synthetic mesh sublay reinforcement. Ann Surg 264:226–232 - DOI
    1. Daes J (2014) Endoscopic subcutaneous approach to component separation. J Am Coll Surg 218:e1–e4 - DOI

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