Sutured Repair of Primary Small Umbilical and Epigastric Hernias: Concomitant Rectus Diastasis Is a Significant Risk Factor for Recurrence

Köhler, Gernot; Luketina, Ruzica-Rosalia; Emmanuel, Klaus

doi:10.1007/s00268-014-2765-y

Cited by 129 publications

(81 citation statements)

References 22 publications

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“…The presence of a rectus diastasis and a concomitant umbilical or epigastric hernia presents a significant challenge with respect to operative management. The recurrence rate after small umbilical or epigastric hernia repair with a concomitant rectus diastasis has been reported to be higher than that in patients without a rectus diastasis. The literature is limited.…”

Section: Resultsmentioning

confidence: 99%

EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances

et al. 2020

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Background Rare locations of hernias, as well as primary ventral hernias under certain circumstances (cirrhosis, dialysis, rectus diastasis, subsequent pregnancy), might be technically challenging. The aim was to identify situations where the treatment strategy might deviate from routine management. Methods The guideline group consisted of surgeons from the European and Americas Hernia Societies. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used in formulating the recommendations. The Scottish Intercollegiate Guidelines Network (SIGN) critical appraisal checklists were used to evaluate the quality of full‐text papers. A systematic literature search was performed on 1 May 2018 and updated 1 February 2019. The Appraisal of Guidelines for Research and Evaluation (AGREE) instrument was followed. Results Literature was limited in quantity and quality. A majority of the recommendations were graded as weak, based on low quality of evidence. In patients with cirrhosis or on dialysis, a preperitoneal mesh repair is suggested. Subsequent pregnancy is a risk factor for recurrence. Repair should be postponed until after the last pregnancy. For patients with a concomitant rectus diastasis or those with a Spigelian or lumbar hernia, no recommendation could be made for treatment strategy owing to lack of evidence. Conclusion This is the first European and American guideline on the treatment of umbilical and epigastric hernias in patients with special conditions, including Spigelian and lumbar hernias. All recommendations were weak owing to a lack of evidence. Further studies are needed on patients with rectus diastasis, Spigelian and lumbar hernias.

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Section: Resultsmentioning

confidence: 99%

EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances

et al. 2020

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“…(5) No existe consenso en relación a las indicaciones ni al tipo de tratamiento quirùrgico sugerido ,pero si la DR es sintomática o asociada con hernias de línea media (umbilical y/o epigástrica), la cirugía concomitante sería la opción más válida.…”

Section: Drunclassified

Endoscopic Approach of Rectus Diastasis and Abdominal Midline Defects

2017

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RESUMENLa Diástasis de los rectos (DR)consiste en la separación existente entre los músculos recto anterior del abdomen, no es considerado un defecto herniario sino una alteracion de la línea alba. Se la relaciona con edad, la multiparidad, el aumento de peso y clinicamente se manifiesta con un abombamiento en la linea media y suele acompañar a otros defectos de la linea media ( hernia umbilical y epigástrica).Reportamos el caso de una paciente de 40 años de edad portadora de Diastasis de los rectos de 4 cm que fue sometida a reparación por abordaje endoscópico supraaponeurotico y con refuerzo protésico.Palabras clave: Diastasis de rectos, Reparación endoscópica. ABSTRACTRectus diastasis (RD) consists of the separation between the rectus abdominis anterior muscles, it is not considered a hernia defect but an alteration of the alba line. It is associated with age, multiparity, weight gain and clinically manifests with a bulging of the midline and usually accompanies other midline defects (umbilical and epigastric hernia). We report the case of a 40-year-old female patient with a 4 cm rectus diastasis who underwent repair by supraaponeurotic endoscopic approach and with prosthetic reinforcement.Key Words: Rectus diastasis, Endoscopic approach. INTRODUCCIóNLa diástasis de los rectos(DR) consiste en la separación de los músculos rectos del abdomen en la línea media, una separación de más de 2 cm ya debe ser considerada anormal. Es fácilmente reconocida al examen físico cuando el paciente en decúbito dorsal eleva la cabeza , produciéndose un aumento de la presión intra abdominal en la medida que los músculos se contraen , apreciándose la aparición de una protuberancia fusiforme difusa en la línea media que puede estar ubicada por encima del ombligo o abarcar toda la línea media (1) . ENDOScOPIc APPROAcH Of REcTuS DIASTASIS AND ABDOMINAl MIDlINE DEfEcTSEn esencia no es considerado un defecto herniario, se produce por un adelgazamiento de la línea alba , producto de un aumento de la presión intra abdominal o por alteración del colágeno en situaciones especiales( embarazo, obesidad, ascitis).Clásicamente se lo asocia con el embarazo y el puerperio presentando una prevalencia comprendida entre el 30 y el 70%, no es raro observar su presencia asociada a otros defectos primarios de la línea media ( hernias umbilicales y epigástricas).(2) En esencia no es considerado un defecto herniario, se produce por un adelgazamiento de la línea alba , producto de un aumento de la presión intrabdominal o por alteración del colágeno en situaciones especiales( embarazo, obesidad, ascitis), representando más bien un problema estético, aunque existen estudios que demuestran su asociación a dorsalgias y lumbalgias, trastornos digestivos (estreñimiento) , alteraciones del piso pélvico, eventos que pueden alterar la calidad de vida. La DR esta clásicamente asociada con el embarazo ,los cambios hormonales provocan cambios en los tejidos , produciendo laxitud tisular a nivel de la línea alba, dicho efecto hormonal persiste hasta tres meses post...

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“…Patients with RAD typically are middle-aged and older men with central obesity, or small, fit women who have carried a large fetus or twins to term [1]. Rectus abdominis diastasis is often seen in umbilical and/or epigastric hernia (45%) [2]. Patients with small umbilical and/or epigastric hernia with concomitant RAD, who underwent suture repair, had a significantly higher recurrence rate (31.2% vs. 8.3%; p < 0.001) [2].…”

Section: Introductionmentioning

confidence: 99%

“…Rectus abdominis diastasis is often seen in umbilical and/or epigastric hernia (45%) [2]. Patients with small umbilical and/or epigastric hernia with concomitant RAD, who underwent suture repair, had a significantly higher recurrence rate (31.2% vs. 8.3%; p < 0.001) [2]. The authors concluded that umbilical and/or epigastric hernias, regardless of size, with concomitant RAD require mesh repair owing to unacceptably higher recurrence rates [2].…”

Section: Introductionmentioning

confidence: 99%

“…Patients with small umbilical and/or epigastric hernia with concomitant RAD, who underwent suture repair, had a significantly higher recurrence rate (31.2% vs. 8.3%; p < 0.001) [2]. The authors concluded that umbilical and/or epigastric hernias, regardless of size, with concomitant RAD require mesh repair owing to unacceptably higher recurrence rates [2]. In full-extend RAD instead of a stable linea alba only a very thin membrane extends longitudinally from the xiphoid process to the subumbilical area, also extending laterally on both sides by several centimeters lateral to the midline.…”

Section: Introductionmentioning

confidence: 99%

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Endoscopic-assisted linea alba reconstruction

et al. 2017

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SummaryBackgroundPatients with symptomatic umbilical, trocar, and/or epigastric hernias and concomitant rectus abdominis diastasis represent a growing clinical problem. The optimal management of this complex hernia situation is the subject of debate in the literature. This paper reports the early results of an innovative surgical technique aimed at managing this hernia situation.MethodsEndoscopic-assisted linea alba reconstruction (ELAR) with mesh augmentation is a surgical technique long known in the literature for its good outcome for incisional hernia repair (myofascial release, overlapping herniorrhaphy, Gibson’s operation, shoelace repair, anterior rectus sheath repair, dynamic patch plasty) via a small access route. The early results for 140 patients are presented here.ResultsTwo patients (1.4%) developed postoperative complications requiring redo surgery. These were two cases of diffuse secondary bleeding without an identifiable bleeding source, in one patient with liver cirrhosis and portal hypertension and in another patient receiving treatment with platelet aggregation inhibitors. All other complications were successively managed with conservative treatment. After 1 year, two of 30 patients reported occasional pain, including pain at rest in one patient.ConclusionThe ELAR technique with mesh augmentation is an innovative, minimally invasive surgical procedure for treatment of patients with a complex abdominal wall hernia comprising symptomatic umbilical, trocar, and/or epigastric hernias with concomitant rectus abdominis diastasis.

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Sutured Repair of Primary Small Umbilical and Epigastric Hernias: Concomitant Rectus Diastasis Is a Significant Risk Factor for Recurrence

Cited by 129 publications

References 22 publications

EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances

EHS and AHS guidelines for treatment of primary ventral hernias in rare locations or special circumstances

Endoscopic Approach of Rectus Diastasis and Abdominal Midline Defects

Endoscopic-assisted linea alba reconstruction

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