Extended Endoscopic Linea Alba Reconstruction Glue (eELARG) – New technique for Ventral Hernias in combination with Diastasis Rectaii –Abdominal Muscles Separation
Moshe Dudai MD FACS; Hernia Excellence Center, Tel Aviv, Israel
During the last two years there are advantages leaded by the minimal invasive techniques for repairing Ventral Hernias (VH). Two main understanding are in the base of the new developments: A. The defect in the muscles must be repair by a new Linea Alba (LA) construction, otherwise the functioning of the abdominal wall is negatively affected. B. The Mesh must be attached to the muscle below or above for reducing the recurrent rate. Doing it by minimal invasive technique the surgical trauma and results will be improved. 2015 Wolfgang Reinpold from Hamburg present his MILOS an Endoscopic Assisted preperitoneal technique, followed by Ferdinand Koeckerling from Berlin with ELAR an Endoscopic Assisted technique for LA reconstruction. Guy Voeller from Memphis demonstrated that Glue reinforcing Only mesh, lead to favorite results.
Lastly Diastasis Rectaii (DR) become recognized as pathology leading to pack pain and progressing abdominal wall dysfunction. DR require surgical repair, repairing Umbilical Hernia without the DR will lead to recurrent.
Our eELARG technique started 2017. We use total endoscopic technique, penetrating with optiview trocar and CO2 pressure to the anterior Rectus Sheet (RS) level, exposing it from Xiphoid to Pubis and Costal margin laterally. Any Hernia sac is dissected and repair, relaxing incision done when needed on the lateral aspect of the RS. The LA is duplicated by running non-absorbable suture from Xiphoid to Pubis. Second running suture approximate the medial aspect of the RS. A Mesh is applying over the repair and the muscles, fused immediately to place by Fibrine Glue.
After 20y of Lap IPOM repair and massive open Component Separation, new Endoscopic techniques are emerging for the VH. Our eELARG enable reconstruction of the LA, with extra-strength receiving from the immediate mesh fusing by the glue, all of that with the advantages of minimally invasive Endoscopic technique.