Surgical treatment of complex lateral hernia with large abdominal wall defect

Lateral hernia

P004 Mendel

Background: Complex lateral abdominal wall defects are challenging for surgical treatment.

Methods: We are presenting a case of successful treatment of patient with large lateral postoperative ventral hernia with soft tissue defect of the abdominal wall. Hernia was developed as result of combat trauma. Patient underwent multiple previous operations with bowel and iliac crest resections.

Patient had right lateral abdominal scar after skin graft with defect of aponeurosis, lateral abdominal muscles and iliac crest. Hernia size was 15 cm in length and from 8,5 to 11 cm width located from inguinal to lumbar area. Rectus abdominal muscles were preserved, deviated to the left side. CT showed extensive defect of the soft tissues of lateral abdominal wall with dimensions of 140×105 mm and prolapse of the small and large bowel loops, extensive defect of the right iliac wing. Hernia was classified by Chevrel-Rath as SLW3R0.

Open IPOM (intraperitoneal onlay mesh) hernioplasty with composite mesh (Parietex Composite 25х20 cm) and skin plastic over the mesh was performed. Mesh was placed with an overlap of 5 cm from the edges of the hernia and fixed by interrupted sutures: posteriorly to the fascia of the lumbar muscle; anteriorly to the aponeurosis of the rectus muscle, superiorly to muscular aponeurotic layer and inferiorly to the inguinal area tissues; and with «double crown» type continuous sutures to the edges of the hernia, while the rectus abdominis muscles were tightened to the medial position.

Results: Patient following for 3 years after the operation without recurrence. The patient marks improvement of a posture, walks without a crutch.

Conclusion: Complex lateral hernia defects required individual treatment options. One of them is open intraperitoneal onlay mesh hernioplasty.