Hernia

Introduction:

In this case study, we present a 65-year-old female, who was lean and fragile, and successfully underwent an Onlay Mesh Repair for an Incisional Ventral Hernia. The patient had a history of multiple surgeries for the same condition and was poorly nourished, which posed unique challenge.

Patient History:

65-year-old female presented with dragging pain and swelling in the umbilical quadrant, with general signs of loss of appetite & weight, intermittent fever, pain in abdomen on having food, single episode of vomiting every day. She had undergone surgery for Umbilical Hernia 15 yearsago, recurrence was re operated after 2 years. After 7 years, she again developed swelling at site of previous surgery scar, which was operated upon, in other hospital.

Treatment:

Considering the patient medical history and the associated challenges we took necessary precautions and employed surgical techniques to address these complexities. During the procedure, bowels were immediately underneath the skin of abdomen, and were densely adhered to the mesh & adjacent structures. There was also a large subcutaneous fluid densely adhered to the mesh & adjacent structures. There was also a large subcutaneous fluid collection. We went about separating the bowels from the mesh with extreme surgical care. It was difficult, but we dissected with excellence. Because of fine dissection and removal of adhesions with mesh, we could avoid a further major surgery like resection of bowels and its anastomosis. The abdominal muscular wall defect was closed primarily in a single layer and 15*15 cm mesh was placed in diamond shape, over the closed defect. This was an onlay mesh repair. Drain was kept in subcutaneous area and skin incision was closed. An incidental finding of an ovarian cyst was managed appropriately.Post surgery period was uneventful and drain was removed 3 days after surgery.

Conclusion:

This complex ventral hernia case came to us, at quite a late stage. It was complicated surgery because bowels were closely adherent to skin, which was dissected with diligence. The previously placed mesh was totally fixed to bowels. We created a plane for mesh insertion with meticulous dissection, which was challenging & prolonged. As a result of this surgical process, we could save her umbilicus & we did not have to resect the bowels. This resulted in an expedited recovery, shorter hospital stay, reduced antibiotic usage, and early resumption of regular activities.