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Laparoscopic Repair of Interparietal Abdominal Wall Hernias

Christopher L Kalmar, MD, MBA, Curtis E Bower, MD, FACS. Virginia Tech Carilion

BACKGROUND:  Interparietal hernias are a rare form of abdominal defect where intraabdominal contents protrude between layers of the abdominal wall. Incidence is estimated to be about 0.1 to 1.6 % and more often seen in adult males. There is limited experience using laparoscopic technique for repairing substantially large interparietal hernias.

METHODS:  An 84-year-old female presented for evaluation of left upper abdominal quadrant bulge, which had been present after left flank incision for lumbar spine surgery. CT scan demonstrated an intact external oblique muscle, but the internal oblique and transversus abdominis on the left side were detached from the linea semilunaris with a 10 cm defect. A 53-year-old female presented for evaluation of right flank bulge after right nephrectomy resulting in an interparietal hernia with a 13 cm defect.

In both cases, the peritoneum was opened to allow better exposure of the muscle. We used a #1 barbed synthetic absorbable monofilament suture (StrataFixTM PDSTM, Ethicon, Somerville, NJ) to approximate the linea semilunaris back to the internal oblique running the suture in cranial direction. Thereafter, we reversed the direction to return running the suture in caudal direction prior to cutting the stitch. Next, attention was turned to mesh reinforcement of the incisional hernia. We placed a 15 x 10 cm monofilament macroporous composite mesh (SymbotexTM, Covidien Medtronic, Mansfield, MA) in underlay fashion securing it to the abdominal wall using a laparoscopic absorbable tack fixation device (AbsorbaTackTM, Covidien Medtronic, Mansfield, MA).

RESULTS:  The patients did well postoperatively and were both discharged on the first postoperative day. At one-month and two-month postoperative follow-up, our patients continued to do well with resolution of abdominal wall discomfort and resolution of abdominal wall hernias.

CONCLUSION:  Our experience demonstrates the largest interparietal hernias treated entirely with laparoscopic repair.  Barbed suture helped maintain suture tension between bites keeping distantly opposing aspects of the muscular abdominal wall securely approximated. In addition to primary suture repair, mesh reinforcement helped offload tension. Moreover, reducing the insufflation pressure during the approximation of the abdominal wall defect was beneficial in ensuring adequate tissue approximation of substantially large abdominal wall defects.  This technique successfully resolved these large interparietal hernias entirely with laparoscopic approach helping patients achieve resolution of their symptoms and abdominal wall irregularity, as well as achieve discharge on the first postoperative day without complication.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 94106

Program Number: V290

Presentation Session: Video Loop Day 3

Presentation Type: VideoLoop

365

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