Laparoscopy complicating abdominal wall plastic surgery: The risks on umbilical transposition

摘要

Dear Sir, We found the recently published case report by Damkat-Thomas et colleagues "Laparoscopy complicating abdominal wall plastic surgery" extremely interesting. They focus on the risk of encountering an asymptomatic hernia during abdominoplasty or liposuction in patients who have underwent previous laparoscopic surgery, stressing as complications from an unexpected hernia can also be fatal, as in case of bowel perforation. As mentioned in their paper, during the last decade the number of laparoscopic procedures performed and the number of surgical indications has dramatically increased. In addition to laparoscopic cholecystectomy, the most performed intervention in the world, there are many other new indications ranging from gynecological surgery to general surgery (hernia, incisional hernia, appendicitis, etc.), including bariatric surgery procedures. Consequently, the rate of umbilical hernias and, therefore, laparoscopic and open repair has increased proportionately. In addition, commenting on the paper of Damkat-Thomas et al., Edmond Cabbabe4 presented another potential and surprising complication of abdominoplasty following laparoscopic procedures: the dense scar tissue from the secondary healing of the infected laparoscopy may entrap bacteria and represent a potential source of infection. We want to draw the reader's attention on further potential implications that previous laparoscopic surgery or umbilical hernia repair may have on abdominoplasty and, precisely, during umbilical transposition. In fact, a potential aggressive coagulation in case of bleeding following the periumbilical laparoscopic incision and prosthetic materials or stitches positioned near the lower umbilicus can severely damage the vascular supply, which could feed in its distal portion, only by the dermal and subdermal plexus.