Gabriel Arevalo, MD1, Jessica Belchos, MD2, Douglas Kaderabek, MD2, Jordan Wilkerson, MD2. 1Case Western Reserve University, 2St Vincent Hospital Indianapolis
Background: Ventral Hernia repair is one of the most common surgical procedures facing the general surgeon.There is little consensus as to the best surgical technique for complex scenarios. Often these patients have complicating co-morbid conditions such as radiation therapy, that has an inevitable effect in the abdominal wall structures, which can lead to non-traditional repairs.
Case report: We present a case of a 62 year-old female who underwent a TAH/BSO and right hemicolectomy which was complicated by wound dehiscence. She underwent primary repair and adjuvant whole pelvis radiation for her squamous cell carcinoma. Subsequently, the patient developed acute obstructive symptoms do to a stricture within her small bowel and a large ventral hernia measuring 14 x 13 cm with non-reducible abdominal contents below the level of the fascia more prominent in the suprapubic area. The patient’s BMI was 15.3.
Various considerations are important in planning a surgical repair in a previously irradiated field with loss of domain which include, minimal dissection, and the use of an atraumatic surgical techniqueque with either external oblique release or transversus abdominis muscle release (TAR). We chose a A TAR, as it provides wider myofascial release and dissection below the arcuate line towards the space of Retzius and Bogros allowing for a larger sublay mesh placement. Also it avoids the need of skin flaps reducing the risk for wound complications in under-perfused tissue.
The TAR was performed successfully and there were no intraoperative and postoperative complications. Her follow-up at 6 months revealed no wound complications or hernia recurrence
Conclusion: For patients with compromised tissue and loss of domain a TAR technique may be useful when reconstructing complex abdominal wall hernias. It provides the core principals of hernia repair such as primary fascial closure, wide mesh overlap, and finally it provides a reliable approach for the under-perfused tissue without need of skin and soft tissue flap creation.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84862
Program Number: P058
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster