ABSTRACT
While diastasis recti (DR) was long neglected by general surgeons, plastic surgeons considered conventional abdominoplasty as the only repair option. However, this scenario has changed recently, either due to a better understanding of the correlation between DR and abdominal wall function and greater risk of recurrence in abdominal hernia repairs, or due to the development of new minimally invasive techniques for repairing DR. One of these surgical procedures consists of the concept of an abdominoplasty, that is, supra-aponeurotic dissection and plication of the DR (with or without abdominal hernia) but performed through three small supra-pubic incisions by laparoscopy or robotic approach. More recently, this procedure has gained new stages. Liposuction and skin retraction technology have been associated with MIS plication of DR, which increases the indications for the technique and potentially improves results. For the first time in the literature, we describe these steps and the synergy between them.
Subject(s)
Lipoabdominoplasty , Minimally Invasive Surgical Procedures , Humans , Minimally Invasive Surgical Procedures/methods , Lipoabdominoplasty/methods , Abdominoplasty/methods , Laparoscopy/methodsABSTRACT
ABSTRACT While diastasis recti (DR) was long neglected by general surgeons, plastic surgeons considered conventional abdominoplasty as the only repair option. However, this scenario has changed recently, either due to a better understanding of the correlation between DR and abdominal wall function and greater risk of recurrence in abdominal hernia repairs, or due to the development of new minimally invasive techniques for repairing DR. One of these surgical procedures consists of the concept of an abdominoplasty, that is, supra-aponeurotic dissection and plication of the DR (with or without abdominal hernia) but performed through three small supra-pubic incisions by laparoscopy or robotic approach. More recently, this procedure has gained new stages. Liposuction and skin retraction technology have been associated with MIS plication of DR, which increases the indications for the technique and potentially improves results. For the first time in the literature, we describe these steps and the synergy between them.
RESUMO Embora a diástase de reto abdominal (DR) tenha sido negligenciada por muito tempo pelos cirurgiões gerais, os cirurgiões plásticos consideravam a abdominoplastia convencional como a única opção de reparo. No entanto, esse cenário mudou recentemente, seja pelo melhor entendimento da correlação entre DR e a função da parede abdominal e o maior risco de recorrência na correção de hérnias abdominais, seja pelo desenvolvimento de novas técnicas minimamente invasivas (MIS) para reparo da DR. Um desses procedimentos cirúrgicos consiste no conceito de abdominoplastia, ou seja, dissecção supra-aponeurótica e plicatura da DR (com ou sem hérnia abdominal), mas realizada através de três pequenas incisões suprapúbicas por laparoscopia ou abordagem robótica. Mais recentemente, esse procedimento ganhou novas etapas. A lipoaspiração e a tecnologia de retração da pele têm sido associadas à plicatura MIS da DR, o que aumenta as indicações da técnica e potencialmente melhora os resultados. Pela primeira vez na literatura, descrevemos essas etapas e a sinergia entre elas.
ABSTRACT
El tratamiento de la diástasis abdominal en pacientes con colgajo dermograso no está estandarizado y puede realizarse mediante diferentes técnicas. Presentamos una alternativa para el manejo miniinvasivo de pacientes con diástasis abdominal asociada a colgajo dermograso mediante la combinación de tres procedimientos que denominamos "táctica VER": Vaser® + endoscopia + Renuvion®. Según nuestra experiencia preliminar, la combinación de los 3 procedimientos es segura y efectiva en los casos seleccionados
The treatment of abdominal diastasis in patients with a dermo-fat flap is not standardized and can be performed using different techniques. We present an alternative for the minimally invasive management of patients with abdominal diastasis associated with dermo-fat flap through the combination of three procedures that we call "VER tactic": Vaser® + Endoscopy + Renuvion®. Based on our preliminary experience, the combination of the 3 procedures is safe and effective in selected cases
Subject(s)
Humans , Postoperative Care , Surgical Flaps/transplantation , Lipectomy/methods , Collagen , Abdominal Muscles/surgery , Minimally Invasive Surgical Procedures/methods , Endoscopy/methods , Abdominoplasty/methods , Diastasis, Muscle/surgeryABSTRACT
INTRODUCTION: Diastasis recti is a common condition with functional and cosmetic effects that can occur in both female and male patients. However, it is more prevalent in females after pregnancies and can be associated with midline hernias. The preaponeurotic endoscopic repair (REPA) has become an emerging procedure for the surgical treatment of this condition. CASES REPORT: We present four cases of vasomotor changes in the abdominal skin, during physical activity or heat exposure, limited to the subcutaneous dissection area after REPA. All patients reported occasional skin redness (erythema) in the subcutaneous dissection area, triggered by exposure to heat or sunlight. The skin redness subsided completely in all the patients after a few minutes in a cool environment and after cessation of physical activity. DISCUSSION: Recently, subcutaneous preaponeurotic repair of diastasis recti has gained popularity. Changes in abdominal skin sensitivity have been reported, but to the best of our knowledge, this is the first report of what appears to be vasomotor skin changes after these procedures. CONCLUSION: Vasomotor changes can occur after endoscopic dissections of the abdominal skin and subcutaneous tissue. Incidence and causes remain unclear.
Subject(s)
Adult , Female , Cystic Duct , Gallbladder , Abdominal Pain , Surgical Procedures, Operative , UltrasonographyABSTRACT
BACKGROUND: Intraabdominal peritoneal onlay polypropylene (PP) mesh repair of incisional hernia has the potential risk of adhesions, bowel obstructions, and intestinal fistulae. Fresh or cryopreserved human amniotic membrane (HAM) has been tested as an antiadherent layer in animals, with excellent outcomes. However, it has disadvantages: it is difficult to handle, and it is expensive to store. Another processing method is available: drying in a laminar flow hood and gamma irradiation. Because this method impairs the membrane's cell viability, it may affect its antiadherent properties. However, such properties may also result from the collagen matrix and its basement membrane, which remain after drying. The aim of the present study was to asses dried irradiated HAM in adhesion prophylaxis in rats. METHODS: Twenty-four female rats were randomized into two groups. In the first group (control group), PP meshes were placed in the intraabdominal space, and in the second group (treatment group), PP meshes coated with HAM were used. Animals were killed on day 30 after surgery. Adhesions and parietal prosthetic incorporation were assessed macroscopically and expressed as the average percentage of the covered area. The portion of the abdominal wall was then resected for histological testing. RESULTS: The treatment group had a significantly higher percentage of adhesions and parietal incorporation compared with the control group (p = 0.003). Histological testing showed a higher inflammatory response in the treatment group, with an intense foreign body reaction. CONCLUSIONS: Dried irradiated HAM does not prevent adhesion formation in intraabdominal peritoneal onlay PP mesh repair in rats. Any use of this biomaterial in adhesion prophylaxis must be undertaken respecting graft cell viability as much as possible.
