Abstract：
OBJECTIVE: Advancements of minimally invasive techniques leveraged routine repair of concomitant diastasis recti (DR), as those approaches facilitate fascial plication and wide mesh overlap while obviating skin incision and/or undermining. Nevertheless, evidence on the value of such intervention is lacking. We aimed to investigate the management and outcomes of concomitant DR during ventral hernia repair (VHR + DR) from surgeons participating in the Abdominal Core Health Quality Collaborative (ACHQC).
METHODS: Patients who have undergone VHR + DR with a minimum 30-day follow-up complete were identified. Outcomes of interest included operative details, surgical site occurrences (SSO), medical complications, and readmissions.
RESULTS: 169 patients (51% female, median age 46, median body mass index 31 kg/m2) were identified. Most hernias were primary (64% umbilical, 28% epigastric). Median hernia width was 3 cm (IQR 2-4) and median diastasis width and length were 4 cm (IQR 3-6) and 15 cm (IQR 10-20), respectively. Most operations were robotic (79%), with a synthetic mesh (92%) placed as a sublay (72%; 59% retromuscular, 13% preperitoneal). DR was repaired with absorbable (92%) and running suture (93%). Considering our cohort\'s relatively small diastasis and hernia size, a high rate of transversus abdominis release was noted (14.7%). 76% were discharged the same day and the 30-day readmission rate was 2% (2 ileus, 1 pneumonia). SSO rate was 4% (6 seromas, 1 skin necrosis) and only one patient required a procedural intervention.
CONCLUSIONS: ACHQC participating surgeons usually perform VHR + DR robotically with a retromuscular synthetic mesh and close the DR with running absorbable sutures. Short-term complications occurred in approximately 6% of patients and were mainly managed without interventions. Larger studies with longer-term follow-up are needed to determine the value of VHR + DR.
METHODS: Patients who have undergone VHR + DR with a minimum 30-day follow-up complete were identified. Outcomes of interest included operative details, surgical site occurrences (SSO), medical complications, and readmissions.
RESULTS: 169 patients (51% female, median age 46, median body mass index 31 kg/m2) were identified. Most hernias were primary (64% umbilical, 28% epigastric). Median hernia width was 3 cm (IQR 2-4) and median diastasis width and length were 4 cm (IQR 3-6) and 15 cm (IQR 10-20), respectively. Most operations were robotic (79%), with a synthetic mesh (92%) placed as a sublay (72%; 59% retromuscular, 13% preperitoneal). DR was repaired with absorbable (92%) and running suture (93%). Considering our cohort\'s relatively small diastasis and hernia size, a high rate of transversus abdominis release was noted (14.7%). 76% were discharged the same day and the 30-day readmission rate was 2% (2 ileus, 1 pneumonia). SSO rate was 4% (6 seromas, 1 skin necrosis) and only one patient required a procedural intervention.
CONCLUSIONS: ACHQC participating surgeons usually perform VHR + DR robotically with a retromuscular synthetic mesh and close the DR with running absorbable sutures. Short-term complications occurred in approximately 6% of patients and were mainly managed without interventions. Larger studies with longer-term follow-up are needed to determine the value of VHR + DR.
摘要：
目的：微创技术的进步，利用伴随性直肠舒张（DR）的常规修复，因为这些方法有助于筋膜折叠和宽网眼重叠，同时避免皮肤切口和/或破坏。然而，缺乏这种干预措施价值的证据。我们旨在调查参与腹部核心健康质量协作（ACHQC）的外科医生在腹侧疝修补术（VHRDR）期间并发DR的管理和结果。
方法：确定接受VHR+DR并至少完成30天随访的患者。感兴趣的结果包括手术细节，手术部位发生(SSO)，医疗并发症,和再入院。
结果：169名患者（51%为女性，中位年龄46，中位体重指数31kg/m2）。大多数疝是原发性的（64％的脐疝，28%的上腹部)。中位疝宽度为3cm（IQR2-4），中位疝宽度和长度为4cm（IQR3-6）和15cm（IQR10-20），分别。大多数操作都是机器人（79％），与合成网（92％）放置为基础（72％；59％的肌肉后，13%腹膜前)。DR用可吸收(92%)和连续缝合(93%)修复。考虑到我们的队列相对较小的扩张和疝大小，腹横肌释放率很高(14.7%).76%当天出院，30天再入院率为2%(2次肠梗阻，1肺炎）。SSO率为4%(6例血清，1个皮肤坏死），只有一名患者需要手术干预。
结论：ACHQC参与手术的外科医生通常使用肌后合成网机器人进行VHR+DR，并使用可吸收缝线闭合DR。短期并发症发生在大约6％的患者中，主要在没有干预的情况下进行管理。需要更大规模的研究和更长期的随访来确定VHR+DR的价值。
方法：确定接受VHR+DR并至少完成30天随访的患者。感兴趣的结果包括手术细节，手术部位发生(SSO)，医疗并发症,和再入院。
结果：169名患者（51%为女性，中位年龄46，中位体重指数31kg/m2）。大多数疝是原发性的（64％的脐疝，28%的上腹部)。中位疝宽度为3cm（IQR2-4），中位疝宽度和长度为4cm（IQR3-6）和15cm（IQR10-20），分别。大多数操作都是机器人（79％），与合成网（92％）放置为基础（72％；59％的肌肉后，13%腹膜前)。DR用可吸收(92%)和连续缝合(93%)修复。考虑到我们的队列相对较小的扩张和疝大小，腹横肌释放率很高(14.7%).76%当天出院，30天再入院率为2%(2次肠梗阻，1肺炎）。SSO率为4%(6例血清，1个皮肤坏死），只有一名患者需要手术干预。
结论：ACHQC参与手术的外科医生通常使用肌后合成网机器人进行VHR+DR，并使用可吸收缝线闭合DR。短期并发症发生在大约6％的患者中，主要在没有干预的情况下进行管理。需要更大规模的研究和更长期的随访来确定VHR+DR的价值。
