Umbilical Port Site Hernia and Diastasis Recti

Abstract

The port site hernia (PSH) is a specific type of incisional hernia related to the trocar sites of laparoscopic surgery. Diastasis recti of the abdominis muscle (DR) is the separation of the rectus muscle by a certain distance. The present study aims to present our experience with umbilical PSH and concomitant DR and to raise awareness of DR as one of the risk factors of umbilical PSH. Methods:Eighteen patients with umbilical PSH after laparoscopic abdominal surgery, was retrospectively reviewed. Preoperative CT was analyzed to measure the Inter-recti distance (IRD) for all patients. Other factors, such as trocar size, wound infection, obesity (BMI), port extension, suture materials, and pre-existing co-morbidities, were recorded and analyzed.Results: Extension of the port incision was associated with umbilical PSH. Ten out of eighteen umbilical PSH patients (56%) had DR before they had first laparoscopic surgery. Nine (50%) patients showed sarcopenia. Moreover, four out of five recurrences had DR. More than two recurrences were all associated with DR. Conclusion:Port extension and sarcopenia were risk factors of umbilical PSH. Also, DR might be a possible risk factor of umbilical PSH occurrence and recurrence. Surgeons should be aware of the presence of DR before the planning of the laparoscopic surgery by diagnostic imaging. If DR is associated with umbilical PSH, we need to consider the correction of both pathologies at the same time.

A systematic review of the association between parastomal hernia and sarcopenia

“…Of the included studies, one employed a cross-sectional design [25]. Five authors employed a retrospective study design [23,24,[26][27][28]. Two used prospective designs, [29,31], and one was a randomized control trial [30] (see Table 2).…”

“…Then, following a review of the full papers of the remaining hits, six were rejected for the following reasons: did not measure stoma incidence or complications with stomas [18], the study only looked at inguinal hernias [19], sarcopenia was not directly measured [20], surgery was only for colonic perforation [21], not all patients undergoing surgery received a stoma [4], and did not explore the complications of stomas [22] (see Table 1). Thus nine studies were finally included [23][24][25][26][27][28][29][30][31] and form the basis of this review.…”

“…The geographical location of the studies varied between the United States [23,24,29,31], Japan [26,28], China [25], the Netherlands [30] and Korea [27] (see Table 2).…”

“…The mean sample size was 242.5 participants (SD = ±358.6), varying between 18 participants [27] and 1178 participants [31]. There were 2183 patients enrolled in the nine studies (see Table 2).…”

“…There were many different ways the studies reported hernia characteristics. Many studies used predefined criteria; Bailey et al [23] used the ventral working group grade, Ishimaru et al [26], used the Devlin classified parastomal hernia criteria, and Ki et al [27] used Tonouchi et al [33] classification system for PSH. Others used measurements of the hernias; Barnes et al [24] used transverse hernia size, Rinaldi et al [29] used hernia defect area and hernia volume, and Schlosser et al [31] reported hernia location, size, and Does not explore the complications of stomas volume.…”