What happens to the rectus abdominus fascia after laparoscopic ventral hernia repair?

K. R. Van Sickle, M. Baghai, Samer Mattar, S. P. Bowers, A. Ramaswamy, V. Swafford, C. D. Smith, B. J. Ramshaw

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: One criticism of laparoscopic ventral hernia repair (LVH) is that the rectus muscles are not re-approximated to the midline, and the effect of LVH repair on the fascial edges is unclear. Progressive migration of the fascial edges toward the midline has been observed anecdotally, but objective evidence remains limited. The purpose of this study is to observe the effect of LVH repair on the rectus abdominus fascia. Methods: Patients undergoing LVH repair with defects >10 cm in horizontal diameter were identified prospectively and enrolled. All were repaired laparoscopically with intraperitoneal placement of mesh (DualMesh, W.L. Gore and Associates) using a standard approach. Radio-opaque clips were placed at the fascial edges intraoperatively to mark the defect, and plain abdominal films were taken postoperatively (Time 1) to establish the initial distance between clips (measured in cm). A subsequent follow-up film was taken (Time 2), and the difference in clip distance per patient was recorded. Results were analyzed using a chi-squared test. Results: Twelve patients qualified for analysis and their results were compared. Mean fascial defect size was 15.1 cm (range 8.3-22.0). With respect to change in clip distance from Times 1 to 2, three events were observed: (1) Diminished (i.e. medialized), (2) Enlarged, or (3) No Change. Ten patients (83%) medialized, one patient enlarged, and one patient showed no change (χ2 (d.f. = 2) 9.17, p <0.0023). Conclusions: Medialization of the rectus abdominus fascia occurs in the majority of patients undergoing LVH repair. Causes for this phenomenon are unclear: however eliminating intrabdominal pressure with intraperitoneal mesh placement likely plays a role.

Original languageEnglish (US)
Pages (from-to)358-362
Number of pages5
JournalHernia
Volume9
Issue number4
DOIs
StatePublished - Dec 2005
Externally publishedYes

Fingerprint

Ventral Hernia
Rectus Abdominis
Herniorrhaphy
Fascia
Surgical Instruments
Motion Pictures
Pressure
Muscles

Keywords

  • Intraperitoneal mesh
  • Laparoscopic ventral hernia repair
  • Medialization
  • Rectus fascia

ASJC Scopus subject areas

  • Surgery

Cite this

Van Sickle, K. R., Baghai, M., Mattar, S., Bowers, S. P., Ramaswamy, A., Swafford, V., ... Ramshaw, B. J. (2005). What happens to the rectus abdominus fascia after laparoscopic ventral hernia repair? Hernia, 9(4), 358-362. https://doi.org/10.1007/s10029-005-0018-6

What happens to the rectus abdominus fascia after laparoscopic ventral hernia repair? / Van Sickle, K. R.; Baghai, M.; Mattar, Samer; Bowers, S. P.; Ramaswamy, A.; Swafford, V.; Smith, C. D.; Ramshaw, B. J.

In: Hernia, Vol. 9, No. 4, 12.2005, p. 358-362.

Research output: Contribution to journalArticle

Van Sickle, KR, Baghai, M, Mattar, S, Bowers, SP, Ramaswamy, A, Swafford, V, Smith, CD & Ramshaw, BJ 2005, 'What happens to the rectus abdominus fascia after laparoscopic ventral hernia repair?', Hernia, vol. 9, no. 4, pp. 358-362. https://doi.org/10.1007/s10029-005-0018-6
Van Sickle KR, Baghai M, Mattar S, Bowers SP, Ramaswamy A, Swafford V et al. What happens to the rectus abdominus fascia after laparoscopic ventral hernia repair? Hernia. 2005 Dec;9(4):358-362. https://doi.org/10.1007/s10029-005-0018-6
Van Sickle, K. R. ; Baghai, M. ; Mattar, Samer ; Bowers, S. P. ; Ramaswamy, A. ; Swafford, V. ; Smith, C. D. ; Ramshaw, B. J. / What happens to the rectus abdominus fascia after laparoscopic ventral hernia repair?. In: Hernia. 2005 ; Vol. 9, No. 4. pp. 358-362.
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abstract = "Background: One criticism of laparoscopic ventral hernia repair (LVH) is that the rectus muscles are not re-approximated to the midline, and the effect of LVH repair on the fascial edges is unclear. Progressive migration of the fascial edges toward the midline has been observed anecdotally, but objective evidence remains limited. The purpose of this study is to observe the effect of LVH repair on the rectus abdominus fascia. Methods: Patients undergoing LVH repair with defects >10 cm in horizontal diameter were identified prospectively and enrolled. All were repaired laparoscopically with intraperitoneal placement of mesh (DualMesh, W.L. Gore and Associates) using a standard approach. Radio-opaque clips were placed at the fascial edges intraoperatively to mark the defect, and plain abdominal films were taken postoperatively (Time 1) to establish the initial distance between clips (measured in cm). A subsequent follow-up film was taken (Time 2), and the difference in clip distance per patient was recorded. Results were analyzed using a chi-squared test. Results: Twelve patients qualified for analysis and their results were compared. Mean fascial defect size was 15.1 cm (range 8.3-22.0). With respect to change in clip distance from Times 1 to 2, three events were observed: (1) Diminished (i.e. medialized), (2) Enlarged, or (3) No Change. Ten patients (83{\%}) medialized, one patient enlarged, and one patient showed no change (χ2 (d.f. = 2) 9.17, p <0.0023). Conclusions: Medialization of the rectus abdominus fascia occurs in the majority of patients undergoing LVH repair. Causes for this phenomenon are unclear: however eliminating intrabdominal pressure with intraperitoneal mesh placement likely plays a role.",
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AU - Baghai, M.

AU - Mattar, Samer

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AU - Ramaswamy, A.

AU - Swafford, V.

AU - Smith, C. D.

AU - Ramshaw, B. J.

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