Hanh Tran, FRACS, Isidro Turingan, RN, Mai Tran, Marta Zajkowska, RN, Vincent Lam, FRACS,Wayne Hawthorne, MD
Discipline of Surgery, Sydney Medical School, The University of Sydney, Westmead Hospital, Westmead, Australia (Drs. H. Tran, Lam, Hawthorne). Sydney Hernia Specialists Clinic, Sydney, Australia (Turingan, M. Tran, Zajkowska).
Introduction: Evidence-based treatment of abdominal hernias involves the use of prosthetic mesh. However, the most commonly used method of treatment of diastasis of the recti involves plication with non-absorbable sutures as part of an abdominoplasty procedure. This case report describes single-port laparoscopic repair of diastasis of recti and umbilical hernia with prosthetic mesh after plication with slowly absorbable sutures combined with abdominoplasty.
Technique Description: Our patient is a 36-year-old woman with severe diastasis of the recti, umbilical hernia and an excessive amount of redundant skin after two previous pregnancies and caesarean sections. After raising the upper abdominal flap, a single-port was placed in the left upper quadrant and the ligamenturn teres was divided. The diastasis of the recti and umbilical hernia were plicated under direct vision with continuous and interrupted slowly absorbable sutures before an antiadhesive mesh was placed behind the repair with 6 cm overlap, transfixed in 4 quadrants and tacked in place with non-absorbable tacks in a double-crown technique. The left upper quadrant wound was closed with slowly absorbable sutures. The excess skin was removed and fibrin sealant was sprayed in the subcutaneous space to minimize the risk of serorna formation without using drains.
Discussion: Combining single-port laparoscopic repair of diastasis of recti and umbilical hemia repair minimizes inadvertent suturing of abdominal contents during plication, the risks of port site hernias associated with conventional multipart repair and permanently reinforced the midline weakness while achieving “scarless” surgery.
Key Words: Single incision laparoscopic surgery, Diastasis of recti Abdominoplasty.