Repair of Complicated Multiple Incisional Hernia on One Patient: Erlangen InlayOnlay Mesh Repair Combined with Extended Spider-Suture Technique

Resit Demir

doi:10.31487/j.scr.2020.11.04

Abstract

Purpose: Surgical treatment of large ventral hernia after laparotomy is a challenge for surgeons. It becomes even more complicated if there is more than one hernia on the abdominal wall and patients have additional risk factors such as BMI> 30, severe CAD or lung problems. In the following work I would like to introduce you two patients who had exactly these constellations and who could be operated successfully by combining two surgical techniques. Methods: Two high-risk patients, first had a large median and one para median and the second had a median and in the left upper abdomen an incisional hernia. The median hernia was closed in both patients with a mesh according to the Erlangen-Inlay-Onlay Mesh Repair (EIOM) procedure. The lateral incisional hernias were closed with the so-called Extended Spider-Suture Technique (ESST). The patients were then followed up for two years. Results: Both patients were very satisfied after two years and would recommend the operation to others. The clinical and sonographic examination of the two patients showed no evidence of hernia recurrence. Conclusion: The combination of both surgical techniques EIOM and ESST showed that all types of abdominal wall hernias can be treated safely even in high-risk patients.

Highlights

Incisional hernia after a laparotomy is an unsolved problem. 20% of all patients who are operated on using today's closure technique after laparotomy develop an incisional hernia [1]
Large and multiple hernias on one patient is a challenge for the surgeon to handle
Two surgical techniques were used in combination with each other on one patient in order to reduce foreign materials as possible into the abdominal wall and to limit the collateral damage as little as possible

Summary

Introduction

Incisional hernia after a laparotomy is an unsolved problem. 20% of all patients who are operated on using today's closure technique after laparotomy develop an incisional hernia [1]. 20% of all patients who are operated on using today's closure technique after laparotomy develop an incisional hernia [1]. Incisional hernia after a laparotomy is an unsolved problem. It becomes even more complicated if the abdominal wall has several hernias which have arisen after several abdominal operations. There is no standard therapy in this situation. The surgeon must individually decide which technique to use for closing the hernia. I would like to introduce two combined techniques that I have performed on two high risk patients for closing their incisional hernia

Methods

Results

Conclusion