Camila Ortiz Gomez, MD, Coney Bae, MD, Joel S Frieder, MD, Maria C Fonseca, MD, David Romero Funes, MD, Samuel Szomstein, MD, FACS, FASMBS, Raul Rosenthal, MD, FACS, FASMBS, Emanuele Lo Menzo, MD, PhD, FACS, FASMBS. Cleveland Clinic Florida
A 40-year-old with prior orthotopic liver transplant for alcohol-induced cirrhosis presents with a large symptomatic ventral hernia at his cruciate incision measuring 20 x15 cm. Pneumoperitoneum was established using an optical trocar via left subcostal incision. Careful lysis of adhesion was performed using an ultrasonic dissector. The mesh size was chosen to include at least 4 cm coverage on all sides. We chose a pre-made polypropylene mesh measuring 33x25cm with a hydrogel barrier posteriorly. The mesh was introduced into the abdomen, and the cardinal stitches were secured to the abdominal wall in a trans-fascial manner using the suture passer. The mesh was tacked circumferentially with a titanium tacker, ascertaining that the mesh lies taut against the contour of the abdomen. The abdomen was deflated and incisions were closed. Incisional hernias after liver transplant pose a challenge due to its large size and proximity to the costal margin. One can navigate this challenge with strategic tacker placement and possibly suturing the superior edge of the mesh to the peritoneal covering posterior to the ribs allowing a tight approximation of the mesh and the peritoneal cavity.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95221
Program Number: V160
Presentation Session: Panel: How Would You Approach This? Complex and Challenging Hernia Case Presentations
Presentation Type: Panel