Bone anchor as fixation method for abdominal wall reconstruction. A case report about a ten times recurred inguinal hernia

Abstract

Introduction: While the use of bone anchor fixation for abdominal wall reconstruction for supra-pubic incisional hernia is well described (Yee et al., 2008 [1]), we show in this case report, written in line with the SCARE criteria (Agha et al., 2020 [2]), a novel use of this tool as an adjunct in the repair of a ten time recurrent inguinal hernia.

Case report: A 65 years old multiparous, diabetic non-obese female, with previous abdominoplasty was submitted for left inguinal hernia for ten times, between multiples complications between infection, more than one mesh excision by anterior approach and laparoscopic approach. The wide range of procedures culminated in a destruction of the abdominal wall, making it impossible for a usual fixation of mesh in the region. Therefore, a multidisciplinary approach was planned for the patient with a bone anchor as a mesh fixation method. With a year follow up we did not observe a local hernia recurrence.

Clinical discussion: Hernia itself is a multifactorial disease. As a anatomical defect, surgery is the only effective treatment. Our report brings a novel approach to a challenging case with many previous unsuccessful applications of conventional surgeries. Hence, we stimulate the multidisciplinary discussion for enhancing post operatory outcomes and a better point of care for the patient.

Keywords: Bone anchor; Case report; Inguinal hernia; Recurrent hernia.

Image 1

CT scan showing clinical signs of recurred inguinal hernia extending 85 mm through the right inguinofemoral region. CT scan shows small bowel insinuating through the inguinal canal into the herniary sac. There are no signs of obstruction or other complications in this exam. The defect ring shows a hernia neck measuring about 53 mm.

Image 2

Per operatory radioscopy during multi-disciplinary approach of recurrent inguinal hernia. Arrowhead showing the bone anchors for sustenance on the Anterior superior iliac spine (ASIS), and the pubic tubercles and branch, on the circles are marked the tackers aiding the mesh fixation on the abdominal wall.

Image 3

CT scan immediately after surgery and one year after surgery recurrence control. 3.1. image showing a large collection of liquid on surgical site with no indirect signs of infection, such as gas bubbles, 3.2 CT scan on late post operatory not showing any signs of recurrence on inguinofemoral region one year after surgery.

Image 4

Examples of bone anchors used for orthopedic surgery. 4.1 Bone anchor and surgical threads, from left to right: Hexagon ® + Ethibond ® #2, similar to the one used on our report, Hexagon ® + Fiber Wire ® #2, Corkscrew ® + Fiber Wire ® #2 [8].