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Purpose <p>The enhanced-view totally extraperitoneal (eTEP) approach to ventral hernia repair offers durable retro muscular reconstruction with favorable cosmetic outcomes, yet postoperative midline bulge remains a concern. We aimed to evaluate the effect of posterior rectus sheath (PRS) closure on abdominal wall morphology and clinical outcomes after robotic eTEP repair.</p> Methods <p>Retrospective review was done on patients undergoing robotic eTEP retro rectus VHR with PRS closure. Distance between the lineae semilunaris was measured at three timepoints: pre-closure, after anterior fascial closure, and after PRS closure. The PRS-closure cohort was compared with a historical control cohort from a prior institutional study of patients undergoing repair without PRS closure. Postoperative midline bulge was assessed at follow-up and demographic as well as operative characteristics and early outcomes were compared between the groups.</p> Results <p>Twenty-seven patients underwent eTEP with PRS closure. The mean semilunar distance decreased from 21.3&#xa0;cm pre-closure to 19.5&#xa0;cm after anterior closure (1.8&#xa0;cm), then to 16.4&#xa0;cm after PRS closure (additional 4.9&#xa0;cm; total 6.7&#xa0;cm; <i>p</i> &lt; 0.001). Postoperative bulge occurred in 18.5% with PRS closure versus 21.8% without PRS closure (<i>p</i> = 0.794). There were no 30-day readmissions or early recurrences.</p> Conclusions <p>Midline fascial closure without PRS closure narrows semilunar distance by 1.8&#xa0;cm; PRS closure provides an additional 4.9&#xa0;cm reduction, enabling a narrower mesh underlay without affecting early recurrence. The impact of PRS closure on postoperative midline bulge could not be definitively determined. Surgeons should recognize these structural changes and close the PRS selectively; larger, long-term studies are needed.</p>

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Effect of posterior rectus sheath closure on outcomes of enhanced total extraperitoneal ventral hernia repair

  • 期刊论文

  • 发表日期：

    2026年3月6日

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  • Daniel Halpern,
  • Armon Panahi,
  • Katherine Cordero,
  • Jennifer Pan,
  • Tulio Brasiliero Silva Pacheco,
  • Boris Joutovsky,
  • David Halpern

摘要

Purpose

The enhanced-view totally extraperitoneal (eTEP) approach to ventral hernia repair offers durable retro muscular reconstruction with favorable cosmetic outcomes, yet postoperative midline bulge remains a concern. We aimed to evaluate the effect of posterior rectus sheath (PRS) closure on abdominal wall morphology and clinical outcomes after robotic eTEP repair.

Methods

Retrospective review was done on patients undergoing robotic eTEP retro rectus VHR with PRS closure. Distance between the lineae semilunaris was measured at three timepoints: pre-closure, after anterior fascial closure, and after PRS closure. The PRS-closure cohort was compared with a historical control cohort from a prior institutional study of patients undergoing repair without PRS closure. Postoperative midline bulge was assessed at follow-up and demographic as well as operative characteristics and early outcomes were compared between the groups.

Results

Twenty-seven patients underwent eTEP with PRS closure. The mean semilunar distance decreased from 21.3 cm pre-closure to 19.5 cm after anterior closure (1.8 cm), then to 16.4 cm after PRS closure (additional 4.9 cm; total 6.7 cm; p < 0.001). Postoperative bulge occurred in 18.5% with PRS closure versus 21.8% without PRS closure (p = 0.794). There were no 30-day readmissions or early recurrences.

Conclusions

Midline fascial closure without PRS closure narrows semilunar distance by 1.8 cm; PRS closure provides an additional 4.9 cm reduction, enabling a narrower mesh underlay without affecting early recurrence. The impact of PRS closure on postoperative midline bulge could not be definitively determined. Surgeons should recognize these structural changes and close the PRS selectively; larger, long-term studies are needed.