Subcutaneous Videosurgery for Abdominal Wall Defects: A Prospective Observational Study

Abdominal wall defects (AWDs) include recti diastasis and midline hernias (umbilical, epigastric, and incisional). In the coexistence of such fascia defects, simultaneous repair is recommended. Conventional and hybrid techniques have been reported as an option of approach. This study aims to present the results of a total minimal invasive access to treat AWD with mesh reinforcement (subcutaneous videosurgery for abdominal wall defects [SVAWD] technique).

The prospective observational study included patients with small/medium midline incisional hernia and/or multiple AWDs (symptomatic umbilicus and/or an epigastric hernia and/or abdominal rectus diastasis >2 cm) operated between August 2016 and February 2018. The exclusion criteria were, namely, fascia defects >10 cm, complex hernias, excess of skin and/or subcutaneous abdominal fatty tissue, and body mass index >35 kg/m².

Twenty-one patients were treated by SVAWD technique, with a median follow-up of 14 (range 6-22) months. The mean size of all fascia defects was 7.46 cm (range 4.5-10.5). Surgical site occurrence was identified in three (14.3%) patients and surgical site occurrence requiring procedural intervention in two (9.5%). Diabetes mellitus was the only predictor factor for higher intraoperative bleeding (R² = 0.63, P = .025). Fibrin sealant (used for mesh fixation) and transverse abdominis plane (TAP) block with ropivacaine 0.2% were associated with less oral analgesics intake (P < .001 and P < .001, respectively) and fewer complications (P = .005 and P = .034, respectively).

Despite the low number of patients operated, the subcutaneous approach presented has proven to be safe, feasible, and effective, as no major complications and relapse occurred. Still, fibrin sealant and TAP block were associated with fewer complications and less oral analgesics intake.