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Traumatic Abdominal Hernia – Laparoscopic Reduction and Repair by IPOM-Plus

Traumatic Abdominal Hernia - Laparoscopic Reduction and Repair by IPOM-Plus

Background

A 60 year old male, alcoholic patient with hypertension sustained an injury to the right upper abdomen when he tripped and fell laterally on a parapet wall. He was presented to the ER with a tender boggy swelling in the right hypochondrium with tachycardia and normal blood pressure.

Diagnosis And Treatment

MDCT the investigation of choice, which diagnosed an enterocoel with mesentric stranding and dilated bowel with a 6x 4 cm defect, fracture right 7,8, and 9 ribs and old healed left 8&9 ribs no pneumothorax or hemothorax.

MDCT is also helpful in excluding other associated intra-abdominal injuries, which determines our approach to manage open vs laparoscopic and also mesh vs no mesh repair. Recurrence with no mesh is 30%. Most of these are open surgeries. The recurrence after open mesh is 10% and after Laparoscopic mesh repair 7.5%. Apart from recurrence, the other concerns are fluid collection. Mesh related complications like shrinkage, adhesions, bowel adhesions and fistulisation are uncommon if proper mesh are used and fixed safely.

We managed this patient laparoscopically IPOM-Plus with reduction of herniated small bowel, closure of the defect and placing a dual mesh.

Traumatic Abdominal Hernia - Laparoscopic Reduction and Repair by IPOM-Plus

Pre surgery

Traumatic Abdominal Hernia - Laparoscopic Reduction and Repair by IPOM-Plus

Post surgery

 

Traumatic Abdominal Hernia - Laparoscopic Reduction and Repair by IPOM-Plus

Intraperitoneal Onlay Mesh

Traumatic Abdominal Hernia - Laparoscopic Reduction and Repair by IPOM-Plus

Sagittal CT scan showing Hernia

Traumatic Abdominal Hernia - Laparoscopic Reduction and Repair by IPOM-Plus

Dilated loop of bowel

Traumatic Abdominal Hernia - Laparoscopic Reduction and Repair by IPOM-Plus

About Author –

Dr. M. Manisegaran, Consultant Surgical Gastroenterologist, Yashoda Hospital, Hyderabad
MS, M.Ch, DNB, MNAMS, FRCS (ED), FRS (ITALY)

best Surgical Gastroenterologist in hyderabad

Dr. M. Manisegaran

MS, M.Ch, DNB, MNAMS, FRCS (ED), FRS (ITALY)
Consultant Surgical Gastroenterologist

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