Comment to: TESLAR for treatment of umbilical/paraumbilical hernia and rectus abdominus diastasis is associated with una
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LETTER TO THE EDITOR
Comment to: TESLAR for treatment of umbilical/paraumbilical hernia and rectus abdominus diastasis is associated with unacceptable persistent seroma formation. Should subcutaneous endoscopic mesh placement be abandoned? C. Claus1 · F. Malcher2 · L. T. Cavazzola3 Received: 23 July 2020 / Accepted: 13 August 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Dear Editor, We read with special interest the article entitled ‘Total endoscopic assisted linea alba reconstruction (TESLAR) for treatment of umbilical/paraumbilical hernia and rectus abdominus diastasis is associated with unacceptable per‑ sistent seroma formation: a single center experience’ [1]. The authors describe the results of 21 patients operated for umbilical hernia repair associated with plication of associ‑ ated rectus abdominis diastasis (RAD) using the subcutane‑ ous endoscopic dissection with unacceptable postoperative seroma rates, above 80%. Early reports of this technique appeared in the literature since the late 90’s [2], and more recently have attracted the attention of surgeons worldwide. The main described advantages are simultaneous MIS repair of the hernia and RDA; low technical complexity and excellent cosmesis [3]. Nevertheless, the postoperative seroma resulting from the subcutaneous dissection and/or by placing the mesh in an onlay position is the main surgical complication. Several authors have published the results of this technique on more than 260 patients. Despite different names (SCOLA, REPA, TESAR, ELAR, MILAR, SVAWD etc.), they present the same concept with seroma rates varying from 5 to 40% [3–6]. However, the mesh used in those cases was synthetic * C. Claus [email protected] 1
Minimally Invasive Surgery Department, Jacques Perissat Institute, Positivo University, Jeremias Maciel Perretto St, 300, Curitiba 81210‑310, Brazil
2
Department of Surgery, Albert Einstein College of Medicine, Bronx, USA
3
Department of Surgery, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
(absorbable or not) and not biologic [3–5]. In addition to the high incidence, its less favorable evolution also draws attention. The need for punctures (81% of patients) and for a surgical reintervention (38.1% of patients) are significantly higher than those reported by other authors using synthetic meshes, where the seroma had a much more favorable evolu‑ tion with spontaneous resolution in most cases [3]. The authors justify the use of biological meshes with the fact that most of the patients in the study fit the Ven‑ tral Hernia Working Group 3 classification. This sounds awkward since Group 3 represents patients with previous wound infection and/or presence of stoma or violation of the gastrointestinal tract. This is not the common profile of patients undergoing elective umbilical hernia and RAD repair. The authors speculate that other potential causes for seroma could be the use of cyanoacrylate to fix the mesh or electrocautery dissection. However, in some of the other studies
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