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.