LAUSR

Present a modification for the retrorectal dissection during the performance of enhanced view totally extraperitoneal (eTEP) approach for the treatment of supraumbilical hernia associated with rectus diastasis. During eTEP, a new approach to access both retrorectal spaces was performed through an infraumbilical incision. First, we made a 2 cm section in the anterior fascia spanning both sides of the linea alba. Therefore, both retrorectal spaces were dissected with the assistance of a balloon trocar. After this maneuver, a structural trocar was inserted, and CO2 was inssuflated. Then 3 suprapubic trocars were inserted: one at the midline, and the other two medial to both semilunaris lines. After trocar placement, and prior to the inferior crossover the anterior rectus fascia of the infraumbilical incision was closed. The surgery was then performed according to the technique described by Daes and Belyansky. We have performed this approach in 2 consecutive patients with supraumbilical hernia (M3W1 and M3W2) associated with rectus diastasis. We achieve a complete dissection of the retro-muscular spaces in only one step and from the same location, facilitating the crossover. There were no associated intraoperative or postoperative complications. The presented modification of the retrorectal dissection during laparoscopic eTEP for supraumbilical hernias represents a time-saver, safe and feasible alternative for the dissection of retrorectal space during eTEP.