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Combined Abdominoplasty With Umbilical Hernia Repair and Umbilicoplasty (CARP) Technique: A Tension-free, Pedicle-preserving, Umbilical Hernia Repair Technique

Maxwell, Daniel DO; Garcha, Iqbal MD; Wang-Ashraf, Bernadette MD; Alexander, Diane MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 8
doi: 10.1097/01.GOX.0000584232.54084.6d
Aesthetic Abstracts
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Emory University Hosptial, Atlanta, GA

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.

BACKGROUND: Ventral and umbilical hernias present a unique challenge to surgeons caring for postpartum patients with diastasis of the rectus abdominis muscle (DRAM) who are undergoing abdominoplasty. Midline umbilical hernia repair without DRAM plication increases the risk of recurrence, whereas traditional open hernia techniques, especially in combination with abdominoplasty, undermine both peripheral and central umbilical vascular supplies. We review our experience with this novel, tension-free, pedicle-preserving, umbilical hernia repair and umbilicoplasty technique used during abdominoplasty.

METHODS: Patients undergoing combined abdominoplasty, DRAM plications, and umbilical hernia repair (CARP) were reviewed from 2010 to 2019 at a 2-surgeon, esthetic practice. Hernia repairs were performed in conjunction with our colleagues in general surgery (I.G.). Demographic, operative, and outcomes data were assessed. Steps of the technique include: (1) raising the abdominal flap with circumferential umbilical stalk dissection; (2) a 6-cm vertical celiotomy is made caudal or cephalad to the umbilicus; (3) hernia reduction is performed; (4) intraperitoneal hernia repair with running polydioxanone suture, incorporating the base of the umbilical stalk; (5) closure of the celiotomy site; (6) plication of the DRAM with running or interrupted polydioxanone suture which removes tension from the repair; and (7) completion of abdominoplasty.

RESULTS: A total of n = 72 patients were included. The average patient demographic was a 39.1- ± 10.5-year-old multiparous female, body mass index 20.9 ± 7.0, with ≥1 previous abdominal/pelvic surgery (57.0%). The most common previous abdominal surgery was cesarean delivery (43.1%). Five patients had prior umbilical/ventral hernia repairs who presented with recurrence. At 5 years of follow-up, postoperatively, no hernia recurrences occurred. Other complications included 2 (2.7%) cases of delayed healing along the abdominoplasty incision line treated with local wound, 1 (1.4%) case of cellulitis treated with antibiotics, and 1 (1.4%) case of pulmonary embolism treated with anticoagulation. The addition of hernia repair and umbilicoplasty added an average of 14 minutes to our traditional abdominoplasty with DRAM plication procedure time.

CONCLUSION: The CARP procedure is a safe alternative to traditional umbilical/ventral hernia repair and can be performed during standard abdominoplasties with DRAM plication. It adds minimal additional time to traditional abdominoplasty procedures and has a low complication profile complimented by its tension-free design without requiring a mesh.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.