LOSS OF DRAINAGE VACUUM AFTER MINIMAL INVASIVE SUBLAY OPERATION – EARLY INDICATOR FOR AN INTERPARIETAL HERNIA WITH SMALL BOWEL OBSTRUCTION – A CASE REPORT

Abstract

Abstract Background Newer repair techniques for abdominal wall hernias, such as the enchanced-view totally extraperitoneal technique or the mini- or less-open sublay operation are increasingly being used. With these new techniques special complications might occur. Case Report We present an 81-year-old patient with a recurrent ventral incisional hernia after IPOM repair. The preoperative abdominal CT scan showed the hernia defect, measuring 3 × 3 cm. A repair was performed in MILOS technique, the IPOM mesh was removed. The posterior the rectus sheath was closed under slight tension. A Mesh 15 × 15 cm without fixation and a 14 french Redon drainage were inserted. Over the next 4 postoperative days the drainage had a repeatedly loos of vacuum, until the patient developed clinical symptoms of a ileus. A CT scan showed a bowel dysfunction without a clear sign for incarceration. At this point, the suction drainage was without vacuum a total of seven times. A diagnostic laparoscopy was performed and a small bowel loop was found trapped between the implanted mesh and the posterior rectus sheath, as an interparietal retro-rectus hernia (iRRH). The intestinal loop could be removed, no necrosis or ischemia was found. The fascial defect was covered using vicryl mesh patch. Conclusion The role of vacuum drainage remains to be considered. Suction of remaining intraabdominal gas might occur due to fascia dehiscence and CT diagnostics can mislead surgeons decisions. Tension free fascial closure remains of capital importance. Mesh fixation, use of special stitching techniques, transversus-abdominis-release or preoperative application of botulinum toxin should be kept mind.