OC-089 A CHALLENGING REPAIR OF RECURRENT VENTRAL HERNIA IN A PATIENT WITH A PREVIOUS INTRAPERITONEAL MESH AND ABDOMINOPLASTY

Abstract

Abstract Aim To understand the challenges faced in repair of recurrent ventral hernia in a patient with a previous intraperitoneal mesh and abdominoplasty. Introduction Ventral hernias still represent a great challenge for surgeons, especially if they are recurrent. We present a 54-year-old overweight female with complex surgical history and a recurrent incisional hernia. She had a laparoscopic cholecystectomy and port site hernia which was repaired without a mesh. She later underwent a Roux-en-Y Gastric bypass for obesity and developed another port site hernia in lower epigastrium. The incisional hernia was repaired with an intraperitoneal mesh. Finally, she had an abdominoplasty for cosmetic reasons. She presented to our surgical clinic with a clinically palpable recurrent large incisional hernia. Methods The repair was carefully planned with a CT abdomen confirming a 6 cm defect in the upper midline and a large intraperitoneal mesh with multiple metallic tacks. The surgical procedure was as follows: Midline incision and careful dissection of the sac. The intraperitoneal mesh was identified and removed carefully keeping the posterior rectus sheath and peritoneum intact. A posterior component separation technique was performed. Posterior rectus sheath was closed with interrupted absorbable sutures. A tailored polypropylene mesh was placed in retro-rectus space. The anterior rectus sheath was closed with non-absorbable interrupted sutures. Patient had an uneventful postoperative period and was discharged on the third postoperative day. Conclusion Careful patient selection, detailed preoperative planning and expertise in abdominal wall reconstruction result in a successful repair of complex ventral hernias.