Single-incision laparoscopic preperitoneal mesh repair of supra-pubic incisional hernia: A case report

Abstract

IntroductionRepair of supra-pubic incisional hernia is still challenging because of the highest pressure at the lower abdominal wall in the erect position. Recently, laparoscopic preperitoneal mesh repair has been gradually reported.Case presentationA 77-year-old woman underwent single-incision laparoscopic preperitoneal mesh repair under a diagnosis of a supra-pubic incisional hernia, measuring 7 × 4 cm. A single, 2.5-cm, intraumbilical incision was made, followed by creation of the preperitoneal space. Then, the posterior rectus sheath and peritoneum were opened, and laparoscopic exploration was performed. After dissection of the supra-pubic hernia content, the tube for degassing the abdominal cavity was inserted into the abdominal cavity, and the peritoneum and the posterior sheath were closed. The preperitoneal space was dissected gradually, and circular dissection of the hernia sac was performed. The proximal sac (peritoneum) was sutured continuously. A 15 × 10 cm mesh was placed in the preperitoneal space and fixed securely with absorbable tacks at the pubic bone, Cooper's ligament, and the rectus abdominis muscle, respectively. After degassing the preperitoneal space, a second laparoscopic exploration was performed to confirm the secure suture of the peritoneum and no injury of the abdominal organs. At 4-month follow-up, the patient remained well with no signs of recurrence.DiscussionSingle-incision laparoscopic preperitoneal mesh repair could minimize the recurrence of supra-umbilical incisional hernia and perioperative complications.ConclusionSingle-incision laparoscopic preperitoneal mesh repair, offering good cosmetic results, might be useful for repair of supra-pubic incisional hernia.

Non-closure of the Free Peritoneal Flap During Laparoscopic Hernia Repair of Lower Abdominal Marginal Hernia: A Retrospective Analysis

“…(2) erect position; and (3) the fact that this area represents the weakest point of the abdominal wall (1,9,13). In our study, the recurrence rate was 2.9% (2/68 cases) with no statistical significance between the two groups seen through follow-up investigations.…”

“…Recurrence is always the principal problem in lower abdominal marginal hernia. The main reasons for the high rate of recurrence involve the anatomical location and body position with three critical considerations (1,9,13,15,39): (1) the anatomical location including the iliac vessels and bladder;…”

“…Recurrence is always the principal problem in lower abdominal marginal hernia. The main reasons for the high rate of recurrence involve the anatomical location and body position with three critical considerations ( 1 , 9 , 13 , 15 , 39 ): (1) the anatomical location including the iliac vessels and bladder; (2) erect position; and (3) the fact that this area represents the weakest point of the abdominal wall ( 1 , 9 , 13 ). In our study, the recurrence rate was 2.9% (2/68 cases) with no statistical significance between the two groups seen through follow-up investigations.…”

“…Here proximity to important anatomical structures including the urinary bladder and iliac vessels usually leads to inadequate mesh overlaps. Moreover, high abdominal wall pressure occurs in the erect position, thus, the repair technique is challenging with recurrences often following suprapubic hernia surgery (5,(7)(8)(9).…”