EGS P25 Innovative use of Alexis ® O System for tissue retraction in hernia and abdominal wall wound repairs
Authors: Johnston Magnus , Sher Jan , Zino Samer , Tasnim Tasnim 
Published: December 2022

Abstract

Background
Hernial operations may pose significant challenges due to the relaxed, dissected subcutaneous tissues and skin which obscure the surgical field during open reconstructions of the abdominal wall. Difficulty in the operation is exacerbated, in the morbidly obese patient due to the the weight of skin and subcutaneous tissue where clear retraction is of extra benefit. The key to adequate exposure during abdominal wall surgery is symmetrical retraction, failure of such can prolong operative times and increase the work and requirement of of assistants.
Presentation of the use of the Alexis ® O system retractor for skin and subcutaneous tissue retraction in hernia repairs and during abdominal wall closure between Dec 2021 and May 2022.

Methods
The use of Alexis ® O retractor has been used for skin and subcutaneous retraction in nine cases: four ventral abdominal wall hernia repair (with two cases needing posterior component separation), four umbilical/para-umbilical hernia and one for inguinal hernias.

Results
This study demonstrated that the Alexis ® O retractor is a useful adjunct to surgery in all four of the abdominal wall hernias and three of the umbilical hernia repairs. It proved initially difficult to place in the first of the umbilical and in the inguinal hernia repairs due to there being inadequate available sizes or shapes of the retractor. The paper presents a novel and efficient approach to skin and subcutaneous retraction by deployment of the Alexis ® O - a self-expanding wound protector - in hernial repairs. The Alexis ® O retractor allowed equal tension retraction at all points of the incision and dissection, enabling improvedexpose of the whole surgical field, improving the symmetrical retraction and thus facilitating planning and unopposed moving between different positions of the surgical field without the requirement of changing retractor position. Furthermore, it increased the freedom of the assistants hands which allowed them to participate in more skilful task aiding the lead surgeon and improving the efficiency of the operation as a whole. The Alexis ® O provided access to surgical field for both the operating and assisting surgeons, along with improving the field that the instruments could operate in without clashing with a fixed and sometimes bulkymetal retractors.

Conclusions
Conclusions: The use of an Alexis ® O retractor in hernia repairs can improve the overall skin and subcutaneous tissue retraction aiding in abdominal wall closure and hernia repairs including umbilical, para-umbilical and inguinal hernias. It provides effective symmetrical retraction of skin and subcutaneous tissue, providing increased freedom to the surgeons and assistants and helps to avoid instrumental clashes. This study demonstrates that Alexis ® O retractor could be used easily without modification to provide effective subcutaneous and skin retraction in hernia operation including complex abdominal wall reconstruction. Furthermore, more potential application for Alexis ® O retractor could be achieved if wider range and different shapes of the Alexis ® O retractor were made available.