Chintan Patel, MS, DNB, FMAS, FIAGES, FBMS1, Ajay Bhandarwar, MS, FMAS, FIAGES, FBMS, FICS2, Amol Wagh, MS, FMAS, FIAGES, FBMS, FICS2, Eham Arora, MS2, Shubham Gupta, MS2, Dharmesh Dhanani, MS, FNB1. 1Kiran Multi Super Specialty Hospital & Research Center, Surat, India, 2Grant Government Medical College & Sir JJ Group of Hospitals, Mumbai, India
Introduction: Incisional hernias occur at prior operative sites & their repair is one of the most common surgeries in everday clinical practice. Recurrence after repair is related to several risk factors, some of which include uncommon hernial sites, morbid obesity, large defect sizes & prior surgery in an emergency setting.
We present the case of a 61 year old female who suffered an incisional hernia after abdominal hysterectomy in 2006. She underwent two open & one laparoscopic repair of the same, but she suffered a third recurrence for which she underwent a hybrid repair.
Materials & Methods: Intra-operative survey showed multiple previously inserted meshes with dense fibrotic bands & omental adhesions with the hernia recurrence occuring between the inferior border of the mesh & the pubic symphysis. A diligent adhesiolysis was performed to entirely expose the defect. An attempt at primary closure of the defect was made using a loop nylon suture, but the previously inserted meshes & dense fibrotic tissues were a barrier to the same. A hybrid approach was employed where defect closure was performed as in open surgery – this reduces the risk of post-operative seroma & abdominal bulge. A composite intra-peritoneal mesh was fixed laparoscopically, ensuring an overlap which extending beyond the pubic symphysis inferiorly.
Result: Hybrid approach is particularly suited to difficult, recurrent hernia cases, as it is technically less demanding, reduces operative time, allows a secure defect closure & provides an improved abdominal wall contour. Dissection in the pre-peritoneal place was performed to allow a wide overlap of a composite mesh in all directions.
Difficult, recurrent hernias are a difficult clinical entity to treat, with a successively worsening risk of recurrence with each subsequent repair. A thorough clinical & imaging evaluation with a well-planned hybrid approach would combine the advantages of both open & laparoscopic repairs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87281
Program Number: P013
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster