Hybrid laparoscopic/open mesh repair of combined bilateral arcuate line and ventral hernias

Abstract

Arcuate line hernia (ALH) is a rare entity with only few cases reported in the literature. ALH is difficult to diagnose clinically and is most of the time asymptomatic, and there is no real consensus on how to better surgically approach this condition. We hereby present the case of a female patient with a symptomatic partly reducible ventral hernia. At laparoscopy, bilateral ALHs were incidentally identified and simultaneously treated, using a safe hybrid technique. The postoperative outcome was uneventful and she is still symptom-free with no clinical evidence of hernia recurrence at 2-year postsurgery. ALH is an uncommon interstitial parietal hernia and its diagnosis is often incidentally made peri-operatively, thus reinforcing the benefit of laparoscopy. In a most complex situation of combined bilateral ALHs with ventral hernia, a hybrid laparoscopic/anterior approach is a safe alternative and we recommend mesh reinforcement of all defects.

Arcuate line hernia: a case report

“…It is imperative to become familiar with this rare condition to continue improving and innovating the standard of care delivered to patients. Previously, the most common approach to arcuate line hernia repairs was open and laparoscopic techniques [ 2 , 3 ]. Robotic surgical approaches are popular in the field of general surgery [ 4 ].…”

Hernia de la linea arcuata, una patologia poco difundida.

“…Otra técnica que ha sido descrita por E. M. von Meyenfeldt 13 es realizar una técnica mixta, utilizando la laparoscopia para encontrar la ubicación precisa de la hernia, y luego mediante un abordaje transrectal abierto, encontrar la hernia, reducirla y fijar una malla intramuscular (sublay). También R. Berney 14 describe una técnica hibrida para el abordaje de estas hernias, especialmente cuando se asocian a otras hernias, ventrales en su caso.…”

Laparoscopic enhanced view total extraperitoneal repair for rare and elusive arcuate hernia

“…Variations in laparoscopic technique have been described, including transabdominal preperitoneal and intraperitoneal approaches 2,5,6 . However, safe repairs using open and hybrid laparoscopic/open approaches with mesh have also been reported 2,7 …”

“…Currently, no consensus exists on the management of this hernia, although a laparoscopic approach with mesh placement appears to be the most commonly advocated 2,5–7 . Variations in laparoscopic technique have been described, including transabdominal preperitoneal and intraperitoneal approaches 2,5,6 .…”