Welcome to the AHS 2020 ePoster Session. Please scroll down to view all of the submitted posters or press Control-F to search. To view the poster and its abstract, click on the poster image. Many posters also have a brief audio introduction which can be played by going to the bottom of the poster screen.
P054: A NOVEL APPROACH FOR REPAIRING VENTRAL HERNIA COMBINED WITH RECTUS MUSCLES SEPARATION; EXTENDED ENDOSCOPIC HERNIA & LINEA ALBA RECONSTRUCTION GLUE - RFR
Moshe M Dudai, MD, FACS1; Karen F Ittah Golan, MD2; 1Ramat Aviv Medical Center; 2Merav Medical Center
Aims: Any Ventral Hernia (VH) combined with Rectus Muscle Separation (RMS) must be repaired along with repairing the RMS, otherwise there is a high risk for Hernia Recurrence. Open RMS repair is vast and traumatic surgery and Laparoscopy is not effective. At 2015 a new era of repairing Abdominal Wall Hernia by Assisted Endoscopy started with Wolfgang Reinhold’s MILOS procedure (Sublay). This procedure is somewhat complexed and real reconstruction of the Linea Alba (LA) was limited, which done better by Ferdinand Koeckerling’s ELAR technique (Onlay). We perfected the ELAR technique to be fully Endoscopic with Rectus Fascia Release (RFR) and wide mesh fusing to the muscles immediately by Fibrin Glue: Extended Endoscopic Hernia & Linea Alba Reconstruction Glue-RFR (eEHLARglue-RFR), achieving a low traumatic MIS for VH and RMS with excellent surgical and cosmetic results.
Methods: Our eEHLARglue-RFR is a totally endoscopic based technique used since 2017. Penetrating with Opti-view trocar and CO2 pressure to the anterior Rectus Fascia (RF) level is followed by an extensive endoscopic dissection of the sub-cutaneous fat tissue from the RF. Another two 5mm trocars are inserted at the supra-pubic line enabling the dissection up to the Xiphoid and costal margins laterally. Any Hernia sac is dissected, and the content reduced back to the abdominal cavity. Releasing Incisions of the RF – RFR are performed longitudinally in the lateral aspect. The LA is reconstructed by running two layers of non-absorbable sutures from Xiphoid to Pubis. A light Mesh 30X14cm is applied over the repair and the mesh is fused immediately to the muscles by Fibrin Glue. The cavity is irrigated for 20min by 20cc of 12% Hypertonic NaCl and two 7mm JP drains are left in place for 20hr.
Results: 65 patients underwent the eEHLARglue with follow up of 40 months. All had significant RMS of 5-10 X14-28cm combined with primary or recurrent VH. Recovery was smooth with1-3 days of simple analgesics and return to regular activity within 4-7 days. No one had recurrent VH, but two males had limited RMS and tree early cases of Seroma formation.
Conclusions: Our eEHLARglue-RFR enables endoscopic VH repair and LA reconstruction with extra-strength received by immediate mesh fusion to muscles with Fibrin glue. Thus, achieving low traumatic MIS, easy recovering and very effective results – is a perfect solution for patients with VH combined with RMS.
Key words: Ventral Hernia, Rectus Muscles Separation, Lina Alba, Endoscopy, Fibrin glue, Rectus Fascia Release
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