Abstract
IntroductionGiant abdominal wall hernias represent a major challenge to the hernia surgeon in practice today. Of the common abdominal wall hernias, those located in the subcostal region are among the most difficult to repair, and have historically been plagued by higher recurrence rates than other locations, such as the midline. No technique has been identified as the clearly superior choice for hernias of this type.Case presentationWe report a successful repair of a giant, multiply recurrent subcostal hernia with loss of domain in a 45-year-old obese Caucasian man. This was accomplished in a novel fashion, using a porcine acellular dermal matrix (Strattice™) as the floor of the repair, which was fixed to the costal margin using orthopedic bone anchors (Mitek™), then covered with a pedicled omental flap to eliminate dead space and facilitate a more rapid revascularization of the porcine acellular dermal matrix implant.ConclusionsThis case emphasizes the need for a thorough understanding of the challenges of the specific type of hernia defect encountered, as well as knowledge of any available techniques that may be adjunctively employed to enhance the chances of achieving a successful result.
Highlights
Giant abdominal wall hernias represent a major challenge to the hernia surgeon in practice today
This case emphasizes the need for a thorough understanding of the challenges of the specific type of hernia defect encountered, as well as knowledge of any available techniques that may be adjunctively employed to enhance the chances of achieving a successful result
Incisional hernias remain a frequent complication of abdominal surgery and result in approximately 250,000 ventral hernia repairs in the United States annually [1]
Summary
We report a successful repair of a complicated subcostal hernia defect using a novel combination of techniques: a non-crosslinked PADM implant with a generous underlay, fixation to the rib superiorly using the MitekTM bone anchor system, and coverage of the implant using a pedicled omental flap, which served to obliterate dead space, enhance the rate of revascularization, and reduce the chances of seroma formation This case emphasizes the need for a thorough understanding of the challenges of the specific type of hernia defect encountered, as well as knowledge of available techniques that may be adjunctively employed to enhance the chances of achieving a successful result. All authors approved the final version of the manuscript prior to submission
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