Changes in the lateral abdominal wall following endoscopic subcutaneous anterior component separation
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ORIGINAL ARTICLE
Changes in the lateral abdominal wall following endoscopic subcutaneous anterior component separation J. Daes1 · D. Morrell2 · E. M. Pauli2 Received: 8 May 2020 / Accepted: 2 September 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
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
Introduction The management of complex ventral hernias is a process in continued evolution that varies greatly according to the principles, technology, techniques, and materials available at different periods and in different practice locations. Conservative treatment, simple primary closure of defects, * J. Daes [email protected] 1
Department of Minimally Invasive Surgery, Clinica Portoazul, 30 Carrera, Corredor Universitario #1‑850, Consultorio 411, Barranquilla, Colombia
Division of Minimally Invasive and Bariatric Surgery, Department of Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, USA
2
and bridging with meshes have been viewed as the standard of care in previous eras. The current approach to the complex ventral hernia includes primary closure of fascial defec
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