Authors: K R Van Sickle M Baghai S G Mattar S P Bowers A Ramaswamy V Swafford C D Smith B J Ramshaw
Publish Date: 2005/08/05
Volume: 9, Issue: 4, Pages: 358-362
Abstract
Background One criticism of laparoscopic ventral hernia repair LVH is that the rectus muscles are not reapproximated to the midline and the effect of LVH repair on the fascial edges is unclear Progressive migration of the fascial edges toward the midline has been observed anecdotally but objective evidence remains limited The purpose of this study is to observe the effect of LVH repair on the rectus abdominus fascia Methods Patients undergoing LVH repair with defects 10 cm in horizontal diameter were identified prospectively and enrolled All were repaired laparoscopically with intraperitoneal placement of mesh DualMesh WL Gore and Associates using a standard approach Radioopaque clips were placed at the fascial edges intraoperatively to mark the defect and plain abdominal films were taken postoperatively Time 1 to establish the initial distance between clips measured in cm A subsequent followup film was taken Time 2 and the difference in clip distance per patient was recorded Results were analyzed using a chisquared test Results Twelve patients qualified for analysis and their results were compared Mean fascial defect size was 151 cm range 83–220 With respect to change in clip distance from Times 1 to 2 three events were observed 1 Diminished ie medialized 2 Enlarged or 3 No Change Ten patients 83 medialized one patient enlarged and one patient showed no change χ2 df=2 917 p00023 Conclusions Medialization of the rectus abdominus fascia occurs in the majority of patients undergoing LVH repair Causes for this phenomenon are unclear however eliminating intrabdominal pressure with intraperitoneal mesh placement likely plays a role
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