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Case Reports
. 2018 Sep 12:34:54-57.
doi: 10.1016/j.amsu.2018.07.014. eCollection 2018 Oct.

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

Masaki Wakasugi  1 , Yujiro Nakahara  1 , Masaki Hirota  1 , Takashi Matsumoto  1 , Takashi Kusu  1 , Hiroyoshi Takemoto  1 , Ko Takachi  1 , Satoshi Oshima  1
Affiliations
Case Reports

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

Masaki Wakasugi et al. Ann Med Surg (Lond). .

Abstract

Introduction: Repair 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 presentation: A 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.

Discussion: Single-incision laparoscopic preperitoneal mesh repair could minimize the recurrence of supra-umbilical incisional hernia and perioperative complications.

Conclusion: Single-incision laparoscopic preperitoneal mesh repair, offering good cosmetic results, might be useful for repair of supra-pubic incisional hernia.

Keywords: Preperitoneal mesh repair; Single-incision laparoscopic surgery (SILS); Supra-pubic incisional hernia.

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Figures

Fig. 1
Fig. 1
Supra-pubic incisional hernia in the standing position.
Fig. 2
Fig. 2
a: Operative setting for supra-pubic incisional hernia, O: operator, C: Camera operator, b: Degassing tube (arrow head).
Fig. 3
Fig. 3
a: Circular dissection of the hernia sac, b: Suturing of the peritoneum.
Fig. 4
Fig. 4
a: Mesh placement and fixation, b: Closure of the peritoneum.
Fig. 5
Fig. 5
Postoperative scar at 4 months after surgery.
See this image and copyright information in PMC

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