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Incisional hernia: laparoscopic hybrid repair

A D'Urso, MD, PhD J Leroy, MD, FRCS T Piardi, MD P Pessaux, MD, PhD J Marescaux, MD, FACS, Hon FRCS, Hon FJSES, Hon FASA, Hon APSA
Epublication WebSurg.com, Nov 2013;13(11). URL: http://websurg.com/doi/vd01en3983

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About 10% of laparotomies are complicated by the development of incisional hernia (1). The prosthetic repair is the rule in the treatment of incisional hernia and is reported to have a lower recurrence rate than primary suture repair (2). The laparoscopic approach proposed since the early nineties with intraperitoneal onlay mesh (IPOM) repair has gained popularity over years. The IPOM technique is easy in case of midline incisional hernia but is more complex in case of lateral suprailiac hernia. The laparoscopic repair is associated with fewer infections as compared to the open technique (3). There are only very few reports on laparoscopic-endoscopic sublay mesh repair of abdominal wall hernias (4, 5). We present the case of a 66-year-old patient admitted for an incisional hernia subsequent to an open liver resection for gallbladder carcinoma in 2011. The patient developed a symptomatic lateral incisional hernia in the right side of his subcostal incision. The oncologic preoperative work-up was negative. The patient was scheduled for a laparoscopic approach with a hybrid onlay and sublay mesh repair. Here, authors aim to propose an original technique with a combined onlay and sublay approach to this complicated lateral abdominal incisional hernia. Bibliographic references: 1. Mudge M, Hughes LE. Incisional hernia: a 10-year prospective study of incidence and attitudes. Br J Surg 1985;72:70-1. 2. Burger JW, Luijendijk RW, Hop WC, Halm JA, Verdaasdonk EG, Jeekel J. Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia. Ann Surg 2004;240:578-83. 3. Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M. Laparoscopic versus open surgical techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 2011;3:CD007781. 4. Schroeder AD, Debus ES, Schroeder M, Reinpold WM. Laparoscopic transperitoneal sublay mesh repair: a new technique for the cure of ventral and incisional hernias. Surg Endosc. 2013;27:648-54. 5. Miserez M, Penninckx F. Endoscopic totally preperitoneal ventral hernia repair. Surg Endosc 2002;16:1207-13.