Onlay repair using self-gripping mesh for lateral trocar site hernia after laparoscopic incisional hernia repair: A case report with short and mid-term outcomes

Abstract

IntroductionTrocar site hernia (TSH) is an uncommon complication after laparoscopic surgery, but may potentially require surgical intervention. The available data have shown the importance of prediction and prevention, and the optimal surgical approach for TSH remains unclear and its long-term outcome is scarcely available. Here, we present a case of a lateral TSH after laparoscopic incisional hernia repair, which was successfully repaired using the onlay technique with a self-gripping mesh.Case PresentationA 74-year-old woman presented with an abdominal incisional hernia at the midline after an open cholecystectomy. She underwent laparoscopic surgery for incisional hernia with intraperitoneal onlay mesh repair. Fascial closure was performed for trocar sites. After 12 months, she noticed a painful bulge in the left upper quadrant suggestive of TSH. At the time of diagnosis, her body mass index was 32 kg/m2. TSH repair was performed under general anesthesia. A 3 × 3 cm defect was identified, and the hernial content was found to be the omentum. Defect closure was performed using interrupted sutures followed by placement of a self-gripping mesh (11 × 11 cm in size, obtaining a 4 cm overlap for the defect). The operative time was 80 min. The postoperative course was uneventful except for a spontaneously resolved seroma. CT scan at the 1-year follow-up and physical examination at the 2-year visit showed no recurrence.ConclusionOur proposed onlay repair using self-gripping mesh may be considered as the treatment of choice for cases of lateral TSH after laparoscopic incisional hernia repair.