ETEP AND TRANSVERSUS ABDOMINIS RELEASE IN A M5W3 INCISIONAL HERNIA

Abstract

Abstract A 59-year-old female who underwent hysterectomy and exploratory laparotomy secondary to seromucinous ovarian carcinoma presents with discomfort in a partially reducible M5W3 incisional hernia. The patient is operated using a full endoscopic minimally invasive extraperitoneal approach (e-TEP + TAR). A 2 cm incision on the right subcostal region is made, exposing and opening the anterior rectal sheath (ARS), medializing the right rectus muscle. A dissection balloon is introduced to release the retromuscular space on the right side. A 10 mm trocar is placed in the right flank and a 5 mm trocar in the right iliac fossa. First, we access the medial posterior rectus sheath (PRS) of the right side, which is then incised, and the preperitoneal dissection is performed doing the crossover above the umbilicus. Once the hernia is completely reduced we connect both the retrorectus space with the preperitoneal spaces on both sides of the hernia. A modified posterior components separation (TAR) is performed on the left side, sectioning the aponeurosis of the transverse muscle (TM) and accessing the preperitoneal space laterally without sectioning the TM. The posterior and anterior defects are then closed separately using a barbed suture. A wide pore mesh, covering both retrorectus and preperitoneal spaces is placed and fixated using glue. An aspiration drainage was placed and removed 24 h after surgery. The patient was discharged the day after and no complications, where reported. In the CT scan 6 months after surgery the correction of the defects where confirmed.