Rectus to defect ratio for estimating the complexity of ventral hernia repair: Is it reliable for robotic surgery? - 22/11/23
, Sarah Davis b, Dawn Blackhurst c, Wil Cobb a, Alfredo Carbonell a, Jeremy Warren aAbstract |
Introduction |
The rectus to defect ratio (RDR) has been previously described as a metric which enables surgeons to estimate the need to perform additional myofascial release (AMR), in addition to open Rives-Stoppa retro-muscular hernia repair. We sought to validate this measurement specifically for patients undergoing robotic totally extraperitoneal (eTEP) hernia repair.
Methods |
A retrospective chart review of 188 patients who underwent robotic ventral hernia repair via eTEP approach. RDR on preoperative CT was compared to the final operation rendered. The primary endpoint was the RDR's ability to predict the need for TAR to achieve fascial closure.
Results |
Of 188 patients, 154 were repaired with rectus myofascial release, while 34 also required TAR. There was a linear decrease in the need for TAR with increasing RDR. RDR 1–1.49 (n = 12) required TAR in 66.7 % of cases, RDR 1.5–1.99 (n = 25) in 43.8 %, RDR 2–2.49 (n = 31) in 29 %, and RDR >2.5 (n = 151) in just 5.8 %
Conclusion |
The RDR accurately predicts the need for TAR to achieve fascial closure during robotic eTEP ventral hernia repair. An RDR >2.5 portends fascial closure without TAR 94.2 % of cases.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Abdominal wall compliance is difficult to directly measure, necessitating the use of surrogate measures to estimate the difficulty of a given ventral hernia repair. |
• | The rectus to defect ratio is a simple, widely available, reproducible, and reliable metric to assist in objectifying clinical decisions regarding the complexity of hernia repair and the need for additional myofascial release. |
• | Despite the added tension of pneumo-insufflation, the rectus to defect ratio reliably predicts the need for additional myofascial release in the form of TAR to achieve fascial closure in patients undergoing robotic eTEP |
Plan
Vol 226 - N° 6
P. 917-920 - décembre 2023 Retour au numéro
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