Stapled VTEP (sVTEP), diastasis and the "swollen abdomen".

In the VTEP series, some patients declared that their abdomen was “somewhat swollen”, and the authors suggested that this might be related to disruption of the posterior sheath due to the crossing. Following this observation, we decided to evaluate the systematic repair of the posterior sheath. In 50 consecutive patients operated for ventral hernias, the VTEP procedure was modified, using the linear stapler to perform simultaneous division and closure of the posterior sheath. Perioperative data and short-term results were prospectively assessed. Six (12%) complications occurred: one hematoma, one sudden death at home five days after surgery in a man with history of cardiac disease, and 4 cases of dehiscence of the staple line, which were successively reoperated by suture of the gap and posterior sheath release incision (PSR). With a mean follow-up of 7.5 months (4–12) there were no recurrences and 2 cases of “swollen abdomen”, in patients who undergone PSR. The “swollen abdomen” did not occur when the posterior sheath was repaired without PSR. Preoperative diastasis bulging present in 11 cases, was totally or partially corrected in 8 and 1 cases, respectively, and unchanged in 2 cases. The sVTEP procedure, can contribute to prevent the swollen abdomen and to diastasis correction. The PSR can prevent staple line disruption or permit tension-free repair of the dehiscence, but then, the newly created lateral gaps can finally entail the same drawback. Search for the best solution to treat the gap in the posterior sheath requires further studies.