A Traumatic Abdominal Wall Hernia Repair: A Laparoscopic Approach

Abstract

Traumatic abdominal wall hernia following blunt trauma, although rare, can be successfully managed with a laparoscopic approach.

What We Know About Management of Traumatic Abdominal Wall Hernia: Review of the Literature and Case Report

“…21 Although midline incision for an exploratory laparotomy in the immediate posttrauma setting is the universal approach because it warrants good exposure for assessment and possible repair of the intra-abdominal injuries, in the delayed repair of the TAWH and in the absence of concurrent intraabdominal injuries, local incision and exploration can also be performed. Successful laparoscopic repair of the TAWH has been reported both in adult (3 cases) [22][23][24] and pediatric (2 cases) 25,26 trauma patients in the literature. The patient's instability seems to be a relative contraindication for laparoscopic approach.…”

Traumatic Abdominal Wall Hernia: Early or Delayed Repair?

“…Rarely, repair is complicated by the need to have fixation of mesh to bony landmarks. In spite of this challenge, the laparoscopic approach with tension-free mesh repair of a traumatic abdominal wall hernia can be accomplished successfully using an approach similar to that taken for laparoscopic inguinal hernia repair [25]. Table 1 Criteria for the diagnosis of TAWH [9] • Immediate appearance following the injury without signs of skin penetration • Persisting signs of trauma at the time of consulting with a doctor Table 2 Some suggestions for the management of TAWH [20] • The mechanism of injury should be a deciding factor, whether a patient with TAWH requires an immediate laparotomy or not • If clinically apparent, anterior abdominal hernias appear to have a high rate of associated injuries and need urgent laparotomy • Occult TAWH is diagnosed only by a CT scan and may help in delaying immediate laparotomy or hernia repair…”

The Management of Traumatic Abdominal Wall Flank Hernia Along the Spigelian Aponeurosis Using Component Separation, Synthetic, and Biological Mesh

“…TAWH can occur along any segment of the abdomen. A rare subtype is the traumatic abdominal wall flank hernia (TAWFH) along the spigelian fascia, which occurs in less than 1% of all blunt abdominal traumas [ 1 , 2 ]. The spigelian fascia is located in the anterior abdominal wall adjacent to the semilunar line and lateral to the rectus abdominis muscle and is formed by the fusion of the internal oblique aponeurosis and transversus abdominis aponeurosis [ 3 ].…”

“…The spigelian fascia is located in the anterior abdominal wall adjacent to the semilunar line and lateral to the rectus abdominis muscle and is formed by the fusion of the internal oblique aponeurosis and transversus abdominis aponeurosis [ 3 ]. Flank hernia injuries in this location are often associated with motor vehicle collision (MVC) with deceleration forces, increased intra-abdominal pressure, and the naturally weaker spigelian fascia [ 2 ].…”