Mohammad Saqib Siddiqui, MD1, Tim Tollens, MD2, Muna Baslaim, MD1, Bassam Altalhi, MD3. 1King Fahd Hospital Jeddah, Saudi Arabia, 2Imelda Hospital, Bonheiden, Belgium, 3King Fahd Armed Forces Hospital Jeddah, Saudi Arabia
Introduction: Recurrent/ complicated ventral hernias with significant fascial defects are a surgical challenge. We are presenting a case of multiple recurrent hernia repairs and an enterocutaneous fistula, following multiple caesarean sections and recurrent umblical hernia repairs that was successfully managed with the component separation technique (CST) in conjuction with synthetic and biological mesh application.
Case Summary: A 62 years old multiparous lady, known hypertensive on treatment. She had undergone three caesarean sections and multiple recurrent umblical hernia repairs with mesh over a period of 36 years. Following her last repair, she developed an enterocutaneous fistula. On examination she had a hugely redundant ventral hernia containing small bowel and a midline discharging fistula. Her BMI was 35. The procedure was started with the excision of enterocutaneous small bowel fistula, resection and anastomosis of the small bowel, excision of excess redundant skin. The part of hernial sac was used to construct the inner layer of repair. The wide defect in the anterior abdominal wall was repaired, by reconstruction with CST in combination with the biological mesh sandwitched between the delayed-absorbable, poly-4-hydroxybutyrate (p4hb), knitted, fully resrobable monofilament mesh and non-absorbable polypropylene (Prolene) monofilament mesh. A closed drainage system was inserted subcutaneously. Postoperatively patient was shifted to ICU for mechanical ventilation for 24hrs. After 48hrs patient was shifted to surgical floor. Tazobactum/ Piperacillin intravenously was given for 2 weeks and Abdominal binder for 8 weeks.
Patient had a smooth recovery and was discharged after 2 weeks. About 2 weeks post-discharge she developed clear discharge from abdominal wound in the midline. She was readmitted and an ultrasound, followed by CT Scan revealed subcutaneous seroma collection. A successful CT-guided drainage was done and patient was discharged after a week.
Conclusion: Reconstruction of abdominal wall for the repair of recurrent ventral hernias with large defects can be accomplished by the component separation technique in conjunction with the use of biological, synthetic non-absorbable and delayed absorbable mesh. The presence of enterocutaneous fistula carries a higher risk of infection but is not a contraindication for using mesh in these cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80272
Program Number: P037
Presentation Session: Poster (Non CME)
Presentation Type: Poster