Robotic extended totally extraperitoneal ( eTEP ) repair with transversus abdominis release ( TAR ) for stoma‐site incisional hernia associated with midline and inguinal defect—A video vignette

Résumé fourni par la source

Stoma-site incisional hernias (SSIH) represent a complex subset of abdominal wall defects due to their proximity to the EIT ambivium, the lateral border of the posterior rectus sheath, and their frequent association with midline hernias. We present the case of a 70-year-old man who developed a complex SSIH following open colostomy reversal after a Hartmann's procedure for acute diverticulitis. A robotic extended totally extraperitoneal (eTEP) approach was selected to minimize adhesiolysis and reduce the risk of visceral injury. The operation began with extraperitoneal access and a complete retrorectus dissection, followed by a left transversus abdominis release (TAR) performed in both caudal-to-cranial and cranial-to-caudal directions, carefully excluding the SSIH during the initial stages. Once the stoma-site hernia sac was opened, its contents were reduced, and the TAR was completed to ensure adequate mesh overlap. Posterior and anterior rectus sheath defects, as well as the SSIH defect, were closed using resorbable barbed sutures. A size-tailored, large-pore synthetic mesh was positioned in the retromuscular plane without additional fixation (Video S1). The postoperative course was uneventful except for a mild ileus, which resolved spontaneously. The patient was discharged on postoperative day five, with no complications or recurrence observed during follow-up. In conclusion, adequate overlap and optimal retromuscular mesh placement for a stoma-site incisional hernia can be achieved via the eTEP approach with TAR, which also facilitates the treatment of concomitant defects. Alberto G. Barranquero: Conceptualization, Methodology, Investigation, Visualization, Writing – Original Draft. Jaume Ortega Alcaide: Conceptualization, Methodology, Investigation, Writing – Original Draft. Cristina Gas Ruiz: Validation, Writing – Review & Editing. Yolanda Maestre González: Validation, Resources, Writing – Review & Editing. Alfredo Escartín Arias: Supervision, Project Administration. Rafael Villalobos Mori: Supervision, Project Administration. The authors received no financial support for the research, authorship or publication of this article. R.V.M. has received consultancy honoraria from ABEX Excelencia Robótica, S.L., the distributor of Intuitive in Spain. The remaining authors declare that the research was conducted without any commercial or financial relationships that could be construed as a potential conflict of interest. Written informed consent was obtained from the patient for publication of the video and any accompanying images. Institutional Ethics Committee revision was not required for this case report. Data sharing not applicable to this article as no datasets were generated or analysed during the current study.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.