Resolution of previous interventions
The revision of previous surgeries performed by other teams is an important aspect of our work.
Being second level surgery in correction of previous procedures, each case would deserve a separate treatment.
As a general criterion, in our experience, the transabdominal pre-peritoneal robotic repair route has allowed us to treat otherwise unsolvable cases by taking advantage of an intact and completely different work space.
Typical cases of complex corrective re-operations
A significant percentage of patients undergoing traditional abdominoplasty (tummytuck) for rectus abdominis diastasis can be subject to recurrence of the pathology. In this case we find ourselves in front of a patient who, besides having the large and unsightly scars of abdominoplasty (tummytuck), presents the diastasis, sometimes even more serious than before the initial surgery.
On the other hand, an important percentage of patients undergoing laparoscopic surgery develop chronic pain due to the mesh and especially to its fixation means. An even greater percentage develop adhesion syndrome since these materials are in contact with the abdominal organs. We are therefore faced with patients who have severe digestive problems and often punctiform pain in correspondence of the anchors of fixation of the net (called tucks).
Thereare even cases of perforation of the viscera on the mesh anchors, which protrude into the abdominal cavity and can perforate the intestine.
We therefore often find ourselves surgically revising patients from these two categories: patients who have previously undergone abdominoplasty with anterior plication of the rectus muscles or patients who have previously undergone laparoscopic techniques.
In both cases, in order to solve the situation, the re-intervention must include a demolition phase where the implanted (and displaced) materials are removed at a subcutaneous or endoabdominal level, respectively, to then move on to the reconstructive phase, which will take place in a surgically intact territory through the preperitoneal space.
Finally, we will move on to aesthetic improvement of the scars and eventual leveling of the panniculus adiposus for aesthetic purposes.
Typical cases of minor corrective reinterventions
One of the most common conditions involves revision of previous cesarean sections, which may require correction at various levels: cutaneous, subcutaneous, muscular-aponeurotic, and endoabdominal.
At skin level, one of the main defects of caesarean sections is the scar, which can have an irregular or hypertrophic appearance, being defined respectively as dysmorphic or keloid.
At a subcutaneous level, in Caesarean section outcomes, scar retractions are often found that determine the so-called belly pooch or "step", which is particularly evident when standing since the scar remains fixed to the deep planes while the overlying dermal-adipose panniculus gives way downwards.
At the aponeurotic muscle level there can be structural failures and finally at the endo-abdominal level the presence of adhesions is frequently found, in some cases asymptomatic and in other cases strongly conditioned and symptomatic.
Faced with a caesarean section it is good to consider all these aspects, both aesthetic and clinical, for a fully resolving approach. In our experience we usually treat this type of problem both in isolation and in association with reconstructive surgery for diastasis if necessary.
Other additional abdominal incisions in outcomes of previous surgeries can be framed with similar diagnostic and therapeutic criteria.