Andrew M O’neill, MD1, Katherine H Yancey, MD2. 1MAHEC, 2Mission Health
Introduction: Ventral incisional hernias (VIH) are one of the most common morbidities following abdominal surgery. Although many remain asymptomatic, others can lead to severe complications. Literature review reveals rates of incisional hernia are 13-20% and recurrence following mesh repair is up to 13%. We discuss a rare finding of recurrent VIH following mesh disruption presumably caused during laparoscopic surgery. We feel this particular type of hernia is rare and little publication on the topic is available.
Case Information: We present a 56-year-old nonsmoking, nondiabetic female who was evaluated in the office for recurrent VIH. Patient had a complicated surgical history consisting of multiple abdominal operations including a Hartmann’s procedure, closure of colostomy, incisional hernia repair with GORE TEX Dual mesh, and most recently a laparoscopic cholecystectomy (LC). Patient reported a multi-month history of periumbilical abdominal pain related to hernia sites.
Physical exam showed an obese female (BMII 32), a mildly tender upper abdomen with two fascial defects in the upper and lower midline with reducible contents. CT scan showed a recurrent incisional hernia through a defect in the upper midline hernia mesh containing a portion of the colon without evidence of obstruction. Previous records obtained from her LC identified a supra-umbilical trocar insertion with no comment in regards to visualization or puncture through pre-existing mesh.
Patient was taken for elective open repair. Intra-operative findings were a 3×1 cm hernia defect in the superior aspect of the Dual mesh containing a portion of incarcerated transverse colon. A second hernia defect approximately 4×4 cm in the lower midline below the mesh edge was also noted. After careful dissection and exposure of the fascial defects, the hernia mesh was divided and abdominal contents reduced. Abdomen was closed via a bilateral posterior rectus fascia release with placement of permanent polyester self-gripping mesh in the retrorectus space. Patient tolerated the procedure well and was discharged on postoperative day 2. She was readmitted POD3 with ileus; however, she has not had any further complications with > 6 mos follow up.
Conclusion: Incisional hernia due to laparoscopic mesh disruption remains an uncommon, but potentially dangerous complication of laparoscopic surgery after previous mesh hernia repair. Surgeons should take care to close any disruptions in mesh created by laparoscopic trocar insertions and be sensitive to recurrences in these areas. Also, diligence should be taken to document any disruptions in mesh during subsequent operations as unintended complications may occur.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94965
Program Number: P551
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster
sages_adbutler_leaderboard