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• W4366163627 abstract "Retrorectus repairs are the most preferred form of repair for ventral hernias. They have less seroma formation, surgical site infection, and recurrence. 1 Samuel Parker Sue Mallet Laura Quinn et al. O29 identifying predictors of ventral hernia recurrence: systematic review and meta-analysis. Br J Surg. 2021; 108 (znab396.028)https://doi.org/10.1093/bjs/znab396.028 Crossref Google Scholar This repair was done by open method, but recently, laparoscopic and robotic retrorectus repairs 2 Lee Y.K. Tomey D. Secchi R. Martinino A. Oviedo R. V-009 robotic umbilical hernia repair with retrorectus sublay mesh and plication of rectus diastasis via the transabdominal preperitoneal (TAPP) approach. Br J Surg. 2022; 109 (znac308.261)https://doi.org/10.1093/bjs/znac308.261 Crossref Google Scholar have also gained popularity. As with all techniques, there are some disadvantages to this repair also. One is that when retrorectus repair is done with laparoscopy, it is technically demanding with a longer operative time. Recently, Vergas et al., in a national hernia database analysis, found that in hernias less than 6 cm in size, transversus abdominis release (TAR) was performed in 14% of retrorectus repairs. 3 Vargas M. Olson M.A. Read T.E. et al. S041—Trends and short-term outcomes of three approaches to minimally invasive repair of small ventral hernias. An ACHQC analysis. Surg Endosc. 2022; https://doi.org/10.1007/s00464-022-09629-5 Crossref Scopus (1) Google Scholar This finding is surprising as hernias of this size do not require TAR in other techniques. They explained that it is to avoid tension in the closer of posterior sheath defects (PRS) and concerns about PRS breakdown. We have also come across this several times when we could not approximate the PRS in hernias of< 6 cm defect size and required TAR (3 patients in last one year). TAR can be required for smaller hernias in retrorectus repair, and we describe the possible anatomical causes. 1.In retrorectus repair, we separate the anterior rectus sheath (ARS) from the posterior rectus sheath (PRS) to enter the retrorectus space. The linea alba is around 2 cm wide area. To enter the retrorectus space, we have to go lateral to the 2 cm linea alba region and give the longitudinal incision in PRS on both side. For the approximation of PRS in the closure, around 2 cm more medialization will be required. It is in addition to the defect width. So, a 6 cm defect will be like 8 cm in retrorectus repair. Often there is rectus diastasis, and this extra width of the linea alba (>2 cm) will add to the defect width and needs to be approximated during the PRS closure. 2.Once we separate the ARS and PRS, the tensile strength and bulk will become half the strength when combined. 4 Amorim C.R. Nahas F.X. Souza V.C. et al. Tensile strength of the posterior and anterior layer of the rectus abdominis muscle sheath in cadavers. Acta Cir Bras. 2007; 22: 255-259https://doi.org/10.1590/s0102-86502007000400005 Crossref PubMed Scopus (13) Google Scholar During approximation, the ARS and PRS will not resist even little tension and are likely to tear. This is unlikely when they are combined and have sufficient strength to withstand mild tension, as in IPOM plus, preperitoneal repair, or onlay repair. 3.The muscles and aponeurosis contract once they are divided from their attachments. Once we separate the ARS and PRS, they both contract to a certain extent making their approximation further difficult." @default.
• W4366163627 created "2023-04-19" @default.
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• W4366163627 date "2023-06-01" @default.
• W4366163627 modified "2023-09-28" @default.
• W4366163627 title "Anatomical causes for why retrorectus repair requires component separation at smaller hernia width than other repairs" @default.
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• W4366163627 doi "https://doi.org/10.1016/j.bjps.2023.04.009" @default.
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