Laparoscopic Mesh Repair of Post-Traumatic Complex Suprapubic and Bilateral Inguinal Hernias

Bestoun Ahmed, MD, FRCS, Chester Royals, MD, Ziad Awad, MD, Michael Nussbaum, MD, FACS. University of Florida College of Medicine, Jacksonville.

Laparoscopy has been proven to be an efficient approach to treat abdominal wall hernias. We present a Video on laparoscopic mesh repair of a complex post-traumatic suprapubic and bilateral inguinal hernias. The patient sustained a pelvic fracture and had his symphysis pubis fixed by plate and screws. CT scan showed a huge lower abdominal wall hernia from disruption of muscle attachments to the pelvic bone. Laparoscopy confirmed these findings. 3 ports were used for this procedure. Peritoneum is separated from the suprapubic area, symphysis pubis and both inguinal region structures. Urinary bladder is cautiously dissected off from the pubic bone. There was extensive scarring from previous trauma and surgery. Leak test did not show urine leak from the bladder. A big dual surface mesh is placed with the smooth surface facing the bowel. The mesh is fixed to the abdominal wall by protacks and transfascial sutures. The mesh’s central component is positioned in between symphysis and bladder to prevent recurrence. Its lateral components were used to cover both inguinal weakness areas. Patient tolerated the procedure well and was discharged on the first postoperative day with oral pain medications. No recurrence is seen after one year.
We conclude that laparoscopic single mesh approach is a practical way to repair complex abdominal wall hernia.

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