Endoscopic transversus abdominis release separation in the treatment of patients with midline incisional hernias

V. A. Burdakov; Бурдаков В. А.; A. A. Zverev; Зверев А. А.; S. A. Makarov; Макаров С. А.; V. V. Strizheletsky; Стрижелецкий В. В.; G. M. Rutenburg; Рутенбург Г. М.; N. L. Matveev; Матвеев Н. Л.

doi:10.17816/brmma50539

Endoscopic transversus abdominis release separation in the treatment of patients with midline incisional hernias

Authors: Burdakov V.A.¹, Zverev A.A.¹, Makarov S.A.², Strizheletsky V.V.², Rutenburg G.M.², Matveev N.L.³
Affiliations:
1. Voskresensk regional hospital number 2
2. City Hospital of St. George the Great Martyr
3. The Russian National Research Medical University named after N.I. Pirogov
Issue: Vol 22, No 3 (2020)
Pages: 82-87
Section: Clinical trials
URL: https://journals.rcsi.science/1682-7392/article/view/50539
DOI: https://doi.org/10.17816/brmma50539
ID: 50539

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Abstract

Abstract. The issues of reconstruction of the anterior abdominal wall in patients with median postoperative ventral hernias remain relevant for many years. The paradigm of their treatment is gradually shifting towards functional minimally invasive reconstructions of the anterior abdominal wall. The indications and technical aspects of endoscopic posterior separation surgery are considered. The analysis of 70 transversus abdominis release was carried out. The average age of patients with postoperative ventral hernias was 61,2±10 years. The median follow-up was 14,2±8,2 months and the anaesthesia risk was 2,8±0,5. The mean hernia width was 151,7±73,7 cm² and the implant size was 832,9±243,3 cm². In the early postoperative period complications were observed in 7 (10%) patients, including the one with retromuscular hematoma, four with retromuscular space infection and two with superficial vein thrombophlebitis. Late complications were observed in 6 (8,7%) patients, there were persistent seroma (3) and chronic pain (3). No hernia recurrence was detected during this period. Thus, the use of endoscopic abdominal wall separation reduces the risk of local complications compared to similar open surgery. At the same time, there is a low level of hernia recurrence and a satisfactory quality of life. In total there were 70 (100%) transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal transversus abdominis release operations performed, among them 14 (77,8%) were bilateral transversus abdominis release and 32 (61,5%) were unilateral transversus abdominis release – 4 (22,2%) and 20 (38,4%) respectively were transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal – 10 (14,3%) operations with combined access were performed: 3 (16,7%) and 7 (1,5%) respectively transabdominal preperitoneal plastic transversus abdominis release and endoscopic totally extraperitoneal transversus abdominis release. In 13 (18,6%) cases simultaneous operations occurred, including 7 (10%) laparoscopic cholecystectomy and 6 (8,6%) endoscopic inguinal hernioplasty.

Keywords

endoscopic surgery, posterior abdominal wall muscle separation, postoperative ventral hernia, complications, relapses, quality of life

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References

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