title: Is muscular atrophy a contraindication in laparoscopic abdominal wall defect repair? A prospective study.
abstract: Laparoscopic surgery for abdominal wall hernias improves short-term results as compared with open hernia surgery. However, no evidence exists to recommend this approach for pseudohernias, which are abdominal wall defects postsurgery caused by denervation and muscular atrophy. The purpose  of this study is to analyze whether the laparoscopic approach benefits patients with a pseudohernia. A prospective nonrandomized, single-center clinical study was conducted of 24 patients operated on for pseudohernia. This study was designed with the basic principle of one unit, one surgeon,  one mesh, and two techniques (laparoscopic or open double prosthetic repair). The primary end point was assessment of the abdominal wall according to: 1) abdominal perimeter; 2) computed tomography scan; and 3) degree of satisfaction. The secondary end points were intraoperative parameters  and comorbidity. Laparoscopy offered no benefits in patients with pseudohernias. Open surgery offered no significant differences in intra- and postoperative morbidity, but if the initial weakness improved with a decrease in abdominal perimeter and visceral content, then there was more than  90 per cent satisfaction (P < 0.05). The laparoscopic approach does not improve the bulge caused by abdominal muscle atrophy. The option of a muscular and prosthetic reconstruction provides better clinical and cosmetic results.
authors.affiliation: Department of Surgery, Abdominal Wall Unit, J.M. Morales Meseguer University Hospital, University of Murcia, Faculty of Medicine, Murcia, Spain. moreno-egea@ono.com
authors.forename: Alfredo
authors.initials: A
authors.lastname: Moreno-Egea
authors.forename: Maite
authors.initials: M
authors.lastname: Sanchez-Elduayen
authors.forename: Elena Parlorio
authors.initials: EP
authors.lastname: De Andres
authors.forename: Andres
authors.initials: A
authors.lastname: Carrillo-Alcaraz
mesh_terms: D034861:Abdominal Wall / Q000601:surgery*; D000075202:Contraindications; D003657:Decision Making; D005260:Female; D005500:Follow-Up Studies; D006555:Hernia, Ventral / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009133:Muscular Atrophy / Q000150:complications* / Q000175:diagnosis; D011446:Prospective Studies; D012008:Recurrence; D012720:Severity of Illness Index; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing