Single port component separation: endoscopic external oblique release for complex ventral hernia repair

Kristen E. Elstner, John W. Read, Anita S. W. Jacombs, Rodrigo Tomazini Martins, Fernando Arduini, Peter H. Cosman, Omar Rodriguez-Acevedo, Anthony N. Dardano, Alex Karatassas, Nabeel Ibrahim

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Component separation (CS) is a technique which mobilizes flaps of innervated, vascularized tissue, enabling closure of large ventral hernia defects using autologous tissue. Disadvantages include extensive tissue dissection when creating these myofascial advancement flaps, with potential consequences of significant post-operative skin and wound complications. This study examines the benefit of a novel, ultra-minimally invasive single port anterior CS technique. Methods: This was a prospective study of 16 external oblique (EO) releases performed in 9 patients and 4 releases performed in 3 fresh frozen cadavers. All patients presented with recurrent complex ventral hernias, and were administered preoperative Botulinum Toxin A to their lateral oblique muscles to facilitate defect closure. At the time of elective laparoscopic repair, patients underwent single port endoscopic EO release using a single 20-mm incision on each side of the abdomen. Measurements were taken using real-time ultrasound. Postoperatively, patients underwent serial examination and abdominal CT assessment. Results: Single port endoscopic EO release achieved a maximum of 50-mm myofascial advancement per side (measured at the umbilicus). No complications involving wound infection, hematoma, or laxity/bulge have been noted. All patients proceeded to laparoscopic or laparoscopic-open-laparoscopic intraperitoneal mesh repair of their hernia, with no hernia recurrences to date. Conclusions: Single port endoscopic EO release holds potential as an adjunct in the repair of large ventral hernia defects. It is easy to perform, is safe and efficient, and entails minimal disruption of tissue planes and preserves abdominal wall perforating vessels. It requires only one port-sized incision on each side of the abdomen, thus minimizing potential for complications. Further detailed quantification of advancement gains and morbidity from this technique is warranted, both with and without prior administration of Botulinum Toxin A to facilitate closure.

LanguageEnglish
Pages2474-2479
Number of pages6
JournalSurgical Endoscopy
Volume32
Issue number5
DOIs
Publication statusPublished - 1 May 2018

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Ventral Hernia
Herniorrhaphy
Type A Botulinum Toxins
Abdomen
Umbilicus
Abdominal Wall
Wound Infection
Hernia
Cadaver
Hematoma
Dissection
Prospective Studies
Morbidity
Recurrence
Muscles
Skin
Wounds and Injuries

Keywords

  • Component separation
  • Endoscopic
  • External oblique release
  • Minimally invasive
  • Ventral hernia

Cite this

Elstner, K. E., Read, J. W., Jacombs, A. S. W., Martins, R. T., Arduini, F., Cosman, P. H., ... Ibrahim, N. (2018). Single port component separation: endoscopic external oblique release for complex ventral hernia repair. Surgical Endoscopy, 32(5), 2474-2479. https://doi.org/10.1007/s00464-017-5949-3
Elstner, Kristen E. ; Read, John W. ; Jacombs, Anita S. W. ; Martins, Rodrigo Tomazini ; Arduini, Fernando ; Cosman, Peter H. ; Rodriguez-Acevedo, Omar ; Dardano, Anthony N. ; Karatassas, Alex ; Ibrahim, Nabeel. / Single port component separation : endoscopic external oblique release for complex ventral hernia repair. In: Surgical Endoscopy. 2018 ; Vol. 32, No. 5. pp. 2474-2479.
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title = "Single port component separation: endoscopic external oblique release for complex ventral hernia repair",
abstract = "Background: Component separation (CS) is a technique which mobilizes flaps of innervated, vascularized tissue, enabling closure of large ventral hernia defects using autologous tissue. Disadvantages include extensive tissue dissection when creating these myofascial advancement flaps, with potential consequences of significant post-operative skin and wound complications. This study examines the benefit of a novel, ultra-minimally invasive single port anterior CS technique. Methods: This was a prospective study of 16 external oblique (EO) releases performed in 9 patients and 4 releases performed in 3 fresh frozen cadavers. All patients presented with recurrent complex ventral hernias, and were administered preoperative Botulinum Toxin A to their lateral oblique muscles to facilitate defect closure. At the time of elective laparoscopic repair, patients underwent single port endoscopic EO release using a single 20-mm incision on each side of the abdomen. Measurements were taken using real-time ultrasound. Postoperatively, patients underwent serial examination and abdominal CT assessment. Results: Single port endoscopic EO release achieved a maximum of 50-mm myofascial advancement per side (measured at the umbilicus). No complications involving wound infection, hematoma, or laxity/bulge have been noted. All patients proceeded to laparoscopic or laparoscopic-open-laparoscopic intraperitoneal mesh repair of their hernia, with no hernia recurrences to date. Conclusions: Single port endoscopic EO release holds potential as an adjunct in the repair of large ventral hernia defects. It is easy to perform, is safe and efficient, and entails minimal disruption of tissue planes and preserves abdominal wall perforating vessels. It requires only one port-sized incision on each side of the abdomen, thus minimizing potential for complications. Further detailed quantification of advancement gains and morbidity from this technique is warranted, both with and without prior administration of Botulinum Toxin A to facilitate closure.",
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Elstner, KE, Read, JW, Jacombs, ASW, Martins, RT, Arduini, F, Cosman, PH, Rodriguez-Acevedo, O, Dardano, AN, Karatassas, A & Ibrahim, N 2018, 'Single port component separation: endoscopic external oblique release for complex ventral hernia repair', Surgical Endoscopy, vol. 32, no. 5, pp. 2474-2479. https://doi.org/10.1007/s00464-017-5949-3

Single port component separation : endoscopic external oblique release for complex ventral hernia repair. / Elstner, Kristen E.; Read, John W.; Jacombs, Anita S. W.; Martins, Rodrigo Tomazini; Arduini, Fernando; Cosman, Peter H.; Rodriguez-Acevedo, Omar; Dardano, Anthony N.; Karatassas, Alex; Ibrahim, Nabeel.

In: Surgical Endoscopy, Vol. 32, No. 5, 01.05.2018, p. 2474-2479.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Single port component separation

T2 - Surgical Endoscopy

AU - Elstner, Kristen E.

AU - Read, John W.

AU - Jacombs, Anita S. W.

AU - Martins, Rodrigo Tomazini

AU - Arduini, Fernando

AU - Cosman, Peter H.

AU - Rodriguez-Acevedo, Omar

AU - Dardano, Anthony N.

AU - Karatassas, Alex

AU - Ibrahim, Nabeel

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Background: Component separation (CS) is a technique which mobilizes flaps of innervated, vascularized tissue, enabling closure of large ventral hernia defects using autologous tissue. Disadvantages include extensive tissue dissection when creating these myofascial advancement flaps, with potential consequences of significant post-operative skin and wound complications. This study examines the benefit of a novel, ultra-minimally invasive single port anterior CS technique. Methods: This was a prospective study of 16 external oblique (EO) releases performed in 9 patients and 4 releases performed in 3 fresh frozen cadavers. All patients presented with recurrent complex ventral hernias, and were administered preoperative Botulinum Toxin A to their lateral oblique muscles to facilitate defect closure. At the time of elective laparoscopic repair, patients underwent single port endoscopic EO release using a single 20-mm incision on each side of the abdomen. Measurements were taken using real-time ultrasound. Postoperatively, patients underwent serial examination and abdominal CT assessment. Results: Single port endoscopic EO release achieved a maximum of 50-mm myofascial advancement per side (measured at the umbilicus). No complications involving wound infection, hematoma, or laxity/bulge have been noted. All patients proceeded to laparoscopic or laparoscopic-open-laparoscopic intraperitoneal mesh repair of their hernia, with no hernia recurrences to date. Conclusions: Single port endoscopic EO release holds potential as an adjunct in the repair of large ventral hernia defects. It is easy to perform, is safe and efficient, and entails minimal disruption of tissue planes and preserves abdominal wall perforating vessels. It requires only one port-sized incision on each side of the abdomen, thus minimizing potential for complications. Further detailed quantification of advancement gains and morbidity from this technique is warranted, both with and without prior administration of Botulinum Toxin A to facilitate closure.

AB - Background: Component separation (CS) is a technique which mobilizes flaps of innervated, vascularized tissue, enabling closure of large ventral hernia defects using autologous tissue. Disadvantages include extensive tissue dissection when creating these myofascial advancement flaps, with potential consequences of significant post-operative skin and wound complications. This study examines the benefit of a novel, ultra-minimally invasive single port anterior CS technique. Methods: This was a prospective study of 16 external oblique (EO) releases performed in 9 patients and 4 releases performed in 3 fresh frozen cadavers. All patients presented with recurrent complex ventral hernias, and were administered preoperative Botulinum Toxin A to their lateral oblique muscles to facilitate defect closure. At the time of elective laparoscopic repair, patients underwent single port endoscopic EO release using a single 20-mm incision on each side of the abdomen. Measurements were taken using real-time ultrasound. Postoperatively, patients underwent serial examination and abdominal CT assessment. Results: Single port endoscopic EO release achieved a maximum of 50-mm myofascial advancement per side (measured at the umbilicus). No complications involving wound infection, hematoma, or laxity/bulge have been noted. All patients proceeded to laparoscopic or laparoscopic-open-laparoscopic intraperitoneal mesh repair of their hernia, with no hernia recurrences to date. Conclusions: Single port endoscopic EO release holds potential as an adjunct in the repair of large ventral hernia defects. It is easy to perform, is safe and efficient, and entails minimal disruption of tissue planes and preserves abdominal wall perforating vessels. It requires only one port-sized incision on each side of the abdomen, thus minimizing potential for complications. Further detailed quantification of advancement gains and morbidity from this technique is warranted, both with and without prior administration of Botulinum Toxin A to facilitate closure.

KW - Component separation

KW - Endoscopic

KW - External oblique release

KW - Minimally invasive

KW - Ventral hernia

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U2 - 10.1007/s00464-017-5949-3

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