Intraperitoneal Mesh Repair for Incisional Hernia William B. Hogan1; Yoko Young Sang, MD2; Shabir S. Abadin, MD, MPH3 1Warren Alpert Medical School of Brown University 2Louisiana State University Shreveport 3World Surgical Foundation
Incisional hernias remain an important postoperative complication of any procedure involving a laparotomy incision. Although most incisional hernias remain asymptomatic, incarceration and strangulation are emergent complications requiring prompt diagnosis and intervention. Mesh repair has become widely favored over simple suture repair of abdominal fascial defects in recent decades, though recurrence of incisional hernias remains high. Despite the advent of laparoscopic approaches to hernia repair, open approaches are utilized when numerous adhesions are encountered, laparoscopic access is unsafe, or when laparoscopy is not readily available. We present an open surgical repair of a large incisional hernia involving the abdominal midline and parastomal site in a woman with a history of laparotomy and colostomy with a subsequent reversal for a perforated colon.
Anterior component separation is an abdominal wall reconstruction technique used in the repair of ventral wall defects to avoid the use of prosthetic mesh. The procedure releases the external oblique fascia to provide a tension-free midline approximation.
The patient is a 72-year-old, obese female who has multiple large incisional hernias along an upper midline incision. An anterior component separation technique is used to repair the defect.
An incision is made over the previous abdominal scar. The dissection is carried down to the hernia sac. The hernia sac is then separated from the surrounding tissue to identify the fascial edges. The hernia sacs are removed from the fascia. Surrounding adhesions are lysed. A colotomy occurred, which was repaired in two layers: the outer layer with interrupted 3-0 silk suture, and the inner layer with running 3-0 Vicryl suture. The fascial incision is extended to ensure complete removal of the hernia sacs along with completion of adhesiolysis. Bilateral subcutaneous flaps separating the subcutaneous fascia from the external oblique fascia are developed. Perforating vessels are ligated with 2-0 or 3-0 silk. The dissection is carried laterally to the anterior axillary line. The external oblique fascia is released bilaterally using electrocautery. The midline defect is then closed with running #1 Prolene. After achieving hemostasis, two drains are placed, and the skin is closed.
Yoko Young Sang, MD Resident Physician General Surgery Louisiana State University Shreveport
Shabir Abadin, MD, MPH (Operating Surgeon) Endocrine and General Surgeon World Surgical Foundation
The patient in this case had an emergency exploratory laparotomy and diverting colostomy several years ago for a perforated colon. Following reversal of the colostomy, she developed an incisional hernia that also involved the stomal site. Here, Dr. Abadin performs an intraperitoneal mesh repair while on a surgical mission in Honduras with the World Surgical Foundation.
Peter Fagenholz, MD
Assistant Professor of Surgery
Harvard Medical School
Katherine Albutt, MD
Resident Physician
Harvard Medical School
In this case, Dr. Peter Fagenholz at MGH performs a ventral incisional hernia repair on a 76-year-old female who developed a hernia following a right colectomy for colon cancer.
