V-048 COMBINED ETEP AND OPEN APPROACH FOR M4 AND L3 VENTRAL HERNIA AFTER COMPLICATED INGUINAL HERNIA REPAIR

Abstract

Abstract We present the case of a 49 y-o woman with a previous open inguinal hernia repair with a superficial surgical site infection during the immediate postoperative period. She required surgical debridement and negative pressure therapy. Ten months after surgery she persisted with discharge and inflammatory changes. The preoperative CT-scan revealed a misplaced mesh with chronic inflammatory changes in the right inguinal and hypogastric region. An M4 3,5cm diameter defect with a right lateralized 13×5×10cm hernia sac was also observed. A combined open and eTEP approach for mesh removal and retrorectus hernia repair was proposed. Retrorectus dissection began at the left rectus muscle, using two 5 mm trocars for dissection and after crossover a contralateral Hasson trocar was placed. A M4-5W2 and L3 hernia with omental fat and partial bladder sliding into the hernia sac was observed. The right posterior fascia was fibrotic and laterally retracted. After sac contents were fully mobilized, a right partial TAR was necessary in order to close the peritoneum and obtain an adequate dissection for mesh placement. A 25×20cm polypropylene mesh was placed in the retrorectal space. Using a right inguinal incision, previously infected mesh was removed and a silver coated polypropylene mesh was placed below the anterior fascia. The patient was discharged on the third postoperative day and her one month follow up visit was uneventful. We conclude that in this case a hybrid approach can provide an adequate mesh placement via eTEP, with mesh removal by a less invasive approach.