LAPAROSCOPIC SPIGELIAN HERNIA WITH RE-RECURRENT UMBILICAL HERNIA REPAIR WITH SLEEVE GASTRECTOMY – A RARE CASE REPORT

Jitendra T Sankpal, MBBS, MS, FMAS, FIAGS, FALS¹, Khushboo K Kadakia, MBBS¹, Sweety S Agarwal, MBBS, DNBE¹, Sushrut Sankpal, MBBS², Priyanka Saha, MBBS¹, Ameya S Gadkari, MBBS¹, Atish K Parikh, MBBS¹, Manjiri J Sankpal, MBBS, MS³, Saad Shaikh, MBBS¹, Avinash Gonnade, MBBS¹. ¹Grant Government Medical College And Sir JJ Government Hospitals Mumbai India, ²Rajiv Gandhi Medical College Thane Maharashtra India, ³New Millenium Hospital Sanpada Navi Mumbai India

INTRODUCTION: OBESITY IS ONE OF THE IMPORTANT PRECIPITATING FACTOR FOR OCCURENCE AND RECURRENCE FOR OBVIOUS AND SILENT VENTRAL HERNIAS. REVIEW OF LITERATURE SHOWS VARIOUS STUDIES RECOMMENDING CONCOMITANT REPAIR OF UMBILICAL HERNIA WITH BARIATRIC PROCEDURES LIKE SLEEVE GASTRECTOMY , ROUX-EN-Y GASTRIC BYPASS. BUT HERE WE REPORT PROBABLY THE FIRST CASE IN WORLD LITERATURE WHERE IN INCIDENTALLY DETECTED LEFT SPIGELIAN HERNIA AND IRREDUCIBLE RE-RECURRENT UMBILICAL HERNIA WERE REPAIRED WITH IPOM PLUS ALONG WITH CONCOMITANT SLEEVE GASTRECTOMY SUCCESSFULLY.

MATERIALS AND METHOD: A 36 YEARS OLD FEMALE PATIENT WITH MORBID OBESITY (BMI – 45 ) PRESENTED WITH RE-RECURRENT (TWICE OPERATED) IRREDUCIBLE UMBILICAL HERNIA WITH NO CO-MORBID CONDITIONS. COMPLICATED UMBILICAL HERNIA BEING THE PRIMARY PATHOLOGY WITH OBESITY AS THE PREDOMINANT ETIOLOGICAL FACTOR , THE PATIENT WAS POSTED FOR LAPAROSCOPIC IPOM PLUS WITH SLEEVE GASTRECTOMY. DURING SURGERY, AFTER ADHESIOLYSIS AND REDUCING THE OMENTAL CONTENTS FROM 4 CM X 3 CM UMBILICAL DEFECT, AN ADDITIONAL SPIGELIAN HERNIA WITH OMENTUM AS A CONTENT, WAS INCIDENTALLY NOTED ALONG THE LEFT RECTUS ABDOMINIS MUSCLE. THIS SPIGELIAN HERNIA AND UMBILICAL HERNIA WERE REPAIRED BY IPOM PLUS WITH TWO SEPARATE 15 X 15 CM COMPOSITE MESHES FOLLOWED BY SLEEVE GASTRECTOMY.

DISCUSSION: IT IS NOT UNCOMMON FOR BARIATRIC PATIENTS TO ALSO HAVE VENTRAL HERNIAS, AND DURING DIAGNOSTIC LAPAROSCOPY THE SURGEON SHOULD NOT BE SURPRISED IF ADDITIONALLY MASKED SECONDARY DEFECTS OR SIMULTANEOUS VENTRAL HERNIAS ARE FOUND.

CONCOMITANT LAPAROSCOPIC IPOM PLUS FOR THIS SPIGELIAN HERNIA AND RE-RECURRENT UMBILICAL HERNIA ALONG WITH SLEEVE GASTRECTOMY CAN BE SAFELY PERFORMED FOR FOLLOWING REASONS

• IMMEDIATE SYMPTOMATIC PAIN RELIEF DUE TO REDUCTION OF IRREDUCIBLE HERNIA.
• THE CHANCES OF SUBSEQUENT INCARCARATION AND STRANGULATION WERE REDUCED.
• BY PERFORMING SLEEVE GASTRECTOMY ,OBESITY, AS A RISK FACTOR FOR RECURRENCE OF VENTRAL HERNIA WAS SIGNIFICANTLY REDUCED.
• BY OBVIATING THE NEED FOR SECOND SURGERY , THERE WAS A CUMULATIVE DECREASE IN COST / STRESS / MORBIDITY/ ANAESTHETIC COMPLICATIONS.

CONCLUSION: NUMEROUS STUDIES HAVE SHOWN THE ADVANTAGE OF LAPAROSCOPIC IPOM PLUS WITH SLEEVE GASTRECTOMY OR OTHER BARIATRIC PROCEDURES AND THIS PARTICULAR CASE REPORT HIGHLIGHTS PROBABLY THE FIRST CASE IN WORLD LITERATURE WHERE IN LAPAROSCOPIC IPOM PLUS REPAIR OF SPIGELIAN HERNIA WAS DONE WITH SIMULTANEOUS SLEEVE GASTRECTOMY WITH FAIR AND FAVOURABLE OUTCOME.

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

Abstract ID: 86784

Program Number: P022

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster