A novel method of incisional hernia repair in a diabetic, smoking patient

Abstract

Incisional hernia is a complication of abdominal surgery, either laparotomy or laparoscopy. Some may become so massive that they hamper a patient’s daily life, and become an embarrassment. The incidence of incisional hernia among diabetic, smoking patients is higher than in the general non-diabetic, non-smoking population. Generally, these massive hernias are repaired using a synthetic or a biological mesh, either alone or to bolster a sheath closure. In diabetics and smokers, infection of the mesh invariably occurs, resulting in removal of the prosthesis and recurrence of the hernia. In this case study, a novel repair using the patient’s own tissues to bolster a sheath closure was explored. A diabetic, smoking patient with a massive incisional hernia after surgery for a perforated peptic ulcer, with resultant sepsis and re-laparotomy 5 years prior to this presentation, had the hernia repaired without a mesh, using his residual skin to bolster the component separation closure repair technique. The use of the patient’s autologous tissue resulted in a stable and firm hernia. In this diabetic, smoking patient, the use of autologous tissue for repair of a massive incisional hernia was found to decrease the complications, and it reduced the cost of the operation. Further study to validate the procedure is needed.