Complex giant incisional hernia repair with intraperitoneal mesh: A case report

Abstract

Introduction and importance An incisional hernia is one of the most frequent complications after abdominal surgery, with an estimated incidence of 2–20% after midline laparotomy. They are often caused by poor wound healing. We present the case of a complex giant incisional hernia that was repaired by implanting an intraperitoneal mesh. Case presentation A 63-year-old man with obesity, hypertension, and multiple previous laparotomies, who developed a complex giant incisional hernia (xipho-pubic > 10 cm wide). An open technique repair was decided with the introduction of a large mesh (Parietex ™ Composite) in an intraperitoneal position, covering a 25 × 16 cm hernial ring. After two years, the patient continues to be followed due to a low-output distal enterocutaneous fistula. Clinical discussion Currently, there is no technique or approach that has become a gold standard for ventral incisional hernia repair. The introduction of an intraperitoneal mesh with two surfaces by laparotomy is recommended when there are contraindications for laparoscopic surgery, for example in obese patients, and patients with multiple previous laparotomies. However, it has been reported to be a complex technique with an enterocutaneous fistula rate of 0.3–4%. Conclusion The introduction of a composite mesh represents an alternative surgical technique for the repair of giant incisional hernias.

A morbidly obese patient with large incisional hernia managed with posterior compartment separation sub-lay mesh placement

“…Subclinical acute dehiscence is the formation of gap between the opposed midline fascial edges which leads to incisional hernia. 1,2 Most of the incisional hernias are diagnosed in first 3 years after the major abdominal surgery but some may take 9-10 years before the presentation after surgery.…”