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Plast Reconstr Surg Glob Open
Plast Reconstr Surg Glob Open
GOX
Plastic and Reconstructive Surgery Global Open
2169-7574
Lippincott Williams & Wilkins Hagerstown, MD

GOX-D-24-00774
00020
10.1097/01.GOX.0001063888.16948.90
3
PSTM Abstract Supplement
PSTM Top Abstracts/Posters 2024
Robotic-Assisted Approach to Post Deep Inferior Epigastric Perforator Flap Hernia Repair
Subramaniam Sneha MD 1
An Katie MD 1
Smith Reid BA 1
Tanna Neil MD 1
Smith Mark MD 1
Sugiyama Gainosuke MD 1
Northwell Health
9 2024
18 9 2024
12 Suppl 15-16Copyright © 2024 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

OPEN-ACCESSTRUE
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pmcBACKGROUND: Fascial bulging or hernias post deep inferior epigastric flap range from 3 to 7%, highlighting the possibility of developing disfiguring bulges in the DIEP population. These can range from full hernias where bowel may be involved to aesthetic bulges. Though a small percentage, such results can yield unaesthetic and negative functional results down the line and require further operative interventions. In this abstract, we offer an operative approach to repairing these post DIEP bulges using a robot-assisted, minimally invasive technique.

METHODS: Patients are laid supine on the operating table. Access to the abdominal cavity is created using a Veress or Hassan technique with the placement of a 12mm port for the camera port peri-umbilically. Pneumoperitoneum is established and two other 8mm robot ports are inserted using direct visualization. Trocars are placed about 10cm on either side of the camera port and 10cm from anterior superior iliac spine. 3 instruments are required: hot shears, Cadiere forceps and a large needle driver. Peritoneum is opened intra-abdominally to expose the hernia defect and the hernia sac and contact is carefully dissected out using a combination of sharp dissection and electrocautery. Once hernia sac is removed, fascia is intra-abdominally closed using a running V-lock PDS suture. Progrip mesh is placed to a size that overlies the closed defect, and the peritoneum is closed primarily with a running vicryl stitch. The abdomen is then desufflated and port sites are closed. Patients were reviewed from a single surgeon over one hospital system from 2020 to 2024 at our institution. Patient demographics, surgical characteristics, robot time, and complications were assessed.

RESULTS: 10 patients were identified who met inclusion criteria for a case series evaluation. Mean time from original DIEP to hernia repair was 2.8 years. Mean age was 56.0 years at time of index case and 58.8 years at time of hernia repair. Mean BMI was 31.8. Defects ranged from 2-10cm, repaired mainly with Progrip Mesh that ranged from 12x8cm to 15x15cm in size. One patient had a Spigelian hernia repaired with a Ventralight ST mesh. Other incidental hernias (umbilical, inguinal, femoral) were found in three patients, which were also repaired at the time of surgery. Mean console time was 63 minutes and required three instruments to perform surgery. Most patients were discharged the same day, while two stayed for one post-operative day (post-operative nausea, 24 hours of IV antibiotics). There was a single recurrence of a DIEP hernia bulge, repaired via the open approach 1.7 years after the prior robotic repair.

CONCLUSION: We offer robot-assisted hernia repair as a safe, minimally invasive technique and approach for post-operative DIEP hernia bulges. These procedures are less morbid than some of the open techniques with aesthetically appealing results in an ambulatory setting with discharge on the same day.
