Abbreviations and synonyms of various surgical techniques in management of rectal diastasis with primary ventral hernias
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LETTER TO THE EDITOR
Abbreviations and synonyms of various surgical techniques in management of rectal diastasis with primary ventral hernias A. Dey1 Received: 29 August 2020 / Accepted: 19 October 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Dear Editor, This letter is about the multitude of nomenclatures and abbreviations used to describe techniques, for treating common surgical conditions. It is often said “There are many ways to skin a cat”. I will be delving in the diverse techniques currently used in the field of ‘Hernia’ surgery, in one particular condition. Rectus Diastasis (RD) with or without associated primary hernias presents such an unique situation. There are many different and innovative ways to tackle it, using multiple access routes and using the many layers of muscles and fascia of the abdominal wall to fix the hernial defect and cover it with a prosthesis. Probably because there has been no consensus on the ideal technique of surgical management in RD, various modifications and surgical alternatives continue to evolve with fancy abbreviations to describe the techniques. For RD, Plication, either by open or laparoscopic surgery, has always been the time-tested method. Among its many modifications are ‘single-’ or ‘double-layer’ plication sutures, use of permanent or absorbable sutures, using interrupted or continuous techniques and with or without the usage of the synthetic mesh [1]. The traditional laparoscopic method, until recently has been the Intra Peritoneal Onlay Mesh repair (IPOM). SCOLA (subcutaneous onlay laparoscopic approach) has been the most recently described technique for RD with primary ventral hernias, by Claus et al. in 2019, where a videoendoscopic subcutaneous dissection was followed by an onlay mesh repair [2]. In the intervening years, multiple variants of the techniques were described and published in literature. I am detailing the most prominent ones.
* A. Dey [email protected]; [email protected] 1
Department of General and Laparoscopic Surgery, Sir Ganga Ram Hospital, Old Rajinder Nagar, New Delhi 110060, India
In Laparoscopic Assisted Recti Diastasis Approximation (LARDA), a technique described by Eva Lourdes, the attenuated diastatic Linea alba is plicated laparoscopically using a suture passer with transfacial sutures placed via multiple stab incisions on the skin. The knots are then tied extra-corporeally followed by laparoscopic mesh reinforcement and anchored using transfascial sutures and tacks [3]. Other techniques include endoscopic-assisted or endoscopic mini open sublay repair by Reinpold et al. (MILOS, eMILOS), endoscopic-assisted linea alba reconstruction devised by Kockerling et al. (ELAR and ELAR-plus), enhanced total extraperitoneal ventral hernia repair (eTEP), laparoscopic intracorporeal rectus aponeuroplasty by Gomez et al. (LIRA), preaponeurotic endoscopic repair (REPA) and totally endoscopic sublay (TES) repairs [4]. Sorin Cimpaen used the term Laparoscopic Aponeuroplasty by Subcutaneous and Intra-abdominal
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