Six Year Outcome from a Complex Lateral Wall Hernia Repair with Mesh Strips

Document Type

Conference Proceeding

Publication Date

4-2025

Publication Title

Surgical Endoscopy

Abstract

Introduction: Hernia recurrence can be a very pervasive issue for patients and recent reports show rates of 40% and 70% with and without mesh. Mesh suture was approved by the FDA in 2021, designed as a mid-weight polypropylene network of suture. This case report demonstrates the mesh strips technique with no recurrence seen at six years.

Case Report: Patient is a 69-year-old male who presented with a recurrent ventral hernia and loss of domain along with Pseudomonas infected mesh (Fig. 1). He was taken to the operating room for repair with mesh excision from previous retrorectus, onlay, bridging and underlay mesh. The midline was unable to be closed, therefore a left external oblique myofascial flap release was performed to gain 9 cm of advancement. An absorbable mesh was placed in an underlay fashion and a midline wound vac was placed. On post-operative day 3, the patient was found to have a fascial dehiscence, not at the midline, but at the external oblique release site where all three layers of the abdominal wall had split, measuring 10 9 13 cm (Fig. 2). A wound vac was replaced and Botox was done as it was not able to be closed from undue tension. He was then taken back to the OR, and a Whitman patch was placed to slowly close the defect while the Botox took affect. On post-operative day 21, the defect measured 30 cm long by 12 cm wide. This was closed using 24 ‘‘early mesh propylene strips’’ spaced at 1 cm intervals and reinforced with an absorbable mesh in an underlay fashion with transfascial sutures (Fig. 3). Six years later, he obtained a CT scan to assess inguinal hernias, and there was no recurrence at the midline or external oblique release site (Fig. 4).

Conclusion: This case demonstrates the robust repair of a complex lateral abdominal wall dehiscence using the ‘‘early mesh suture’’ technique with no recurrence at six years.

Volume

39

Issue

Suppl 1

First Page

S139

Last Page

S140

Comments

SAGES Annual Meeting, March 12–15, 2025, Long Beach, CA

DOI

10.1007/s00464-025-11690-9

ISSN

1432-2218

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