Needlescopic surgery for large umbilical hernia in a patient with morbid obesity using intraperitoneal onlay mesh with fascial defect closure: a case report

Abstract

Background The European and American guidelines recommend that symptomatic umbilical hernias (UHs) are repaired using an open approach with a preperitoneal flat mesh. However, the standard treatment procedure for large UH in patients with extreme obesity is yet to be established. Here, we present the first case of a patient with morbid obesity undergoing laparoscopic UH repair using needlescopic instruments and an intraperitoneal onlay mesh plus repair (IPOM plus). Case presentation A 29-year-old man, who was classified as morbidly obese (body mass index, 36.7 kg/m2) noticed a reducible nontender mass in the umbilical region and was subsequently diagnosed with an UH, with a diameter of 4 cm. Laparoscopic IPOM plus repair was planned using a needlescopic method for a large UH in the patient with morbid obesity. A 3-mm rigid laparoscope was mainly used in the procedure. After a 12-mm trocar and two 3-mm trocars were inserted, fascial defect closure was performed using intracorporeal suturing with 0 monofilament polypropylene threads. Then, IPOM was performed laparoscopically using an 11.4-cm round mesh coated with collagen to prevent adhesions. The operative time and blood loss were 57 min and 1 g, respectively. The postoperative course was uneventful. Conclusions Reduced-port laparoscopic surgery using needlescopic instruments and an IPOM plus technique is a minimally invasive and convenient combination option for large UH in a patient with morbid obesity.

Photocurable injectable Janus hydrogel with minimally invasive delivery for all-in-one treatment of gastric perforations and postoperative adhesions

“…Following the all-in-one strategy, laparoscopic hemostasis and blocking acute gastric perforations could be achieved rapidly, and the application of HAD hydrogel barriers could be controlled in real-time by adjusting the degree of HAD hydrogels by surgeons. Due to the all-in-one strategy, the whole procedure of minimal manipulation on minipig models was performed through one trocar channel, leading to a decreased surgical time and a lower risk of trocar-site hernias 31 , 42 , 43 . A continuous and well-integration contact interface between the Janus adhesive HAD hydrogels and perforations tissues was detected in the presence of blood or the moist body fluid at two weeks post-surgery, which effectively prevents gastric contents from leaking into the abdominal cavity.…”

Left paraduodenal hernia treated by single-incision laparoscopic surgery: a case report

“…However, we thought that needlescopic surgery has some drawbacks in this case. Needlescopic surgery requires specialized forceps with its small jaws and supple fine shafts that could cause the excessive tension to the protruded small bowel during pulling out through the hernia orifice [ 11 ]. Another drawback is the limitation of available devices.…”