Successful closure of a large abdominal wall defect using endoscopic component separation technique in an infant with a giant ventral hernia after staged surgery for omphalocele

Background The management of large abdominal wall defects, such as omphalocele or gastroschisis, remains a challenge for pediatric surgeons. Though several techniques have been described to repair those conditions, there is no procedure considered to be the standard worldwide. We report an infant girl with a giant ventral hernia after staged surgery for omphalocele in whom delayed closure of a large abdominal wall defect was performed successfully using “endoscopic component separation technique (ECST)” without serious complications. Case presentation A baby girl was admitted to our hospital because of a giant omphalocele, which had been prenatally diagnosed. The omphalocele was supraumbilical and included the entire liver. After staged surgery, a large abdominal wall defect was closed by skin, creating a giant ventral hernia. We performed endoscopic separation component technique (ECST) for the closure of her abdominal wall defect when she was 11 months of age. ECST was initiated with placement of a 5.0-mm port just above the inguinal ligament and under the external oblique muscle. The space between the external and internal oblique muscles was created by the insufflation pressure, and a second 5.0-mm port was placed at 1.0 cm below the inferior edge of the rib into the space. As the further dissection was carried, the aponeurosis of the external oblique muscle was identified as a white line, running vertically from the epigastrium to inguinal ligament. It was transected longitudinally using electrocautery over its full length. The same procedure was performed on the contralateral side and the abdominal wall was successfully closed. Postoperative course was uneventful. Conclusions The technique of ECST, described here, is simple and safe for infants, and the cosmetic result is satisfactory.

Outcomes and Complications of Open, Laparoscopic, and Hybrid Giant Ventral Hernia Repair

Background This study aimed to compare outcomes and complications between open, laparoscopic, and hybrid (laparoscopic and open combined) approaches in giant ventral hernia repair. Methods Records of patients with giant ventral hernias who received operations from 2006 to 2013 were retrospectively reviewed. Open, laparoscopic, or a hybrid procedure was performed in every case. The primary outcome was hernia recurrence rate, and secondary outcomes included intraoperative and postoperative complications. Results A total of 82 patients received open repair, 94 laparoscopic repair, and 132 hybrid repair. The median hernia diameter was 13.11 ± 3.4 cm. With a mean follow-up of 41 months, the incidence of hernia recurrence in the hybrid procedure group was 1.3%, which was significantly lower than that in the laparoscopic (20.5%) or open procedure group (8.5%) (P < 0.001). The incidence of intraoperative intestinal injury was 6.1% in open, 4.1% in laparoscopic, and only 1.5% in the hybrid procedure (hybrid vs. open and laparoscopic procedures; P < 0.05). Rates of postoperative intestinal fistula formation in the open, laparoscopic, and hybrid groups were 2.4%, 6.8%, and 3.3%, respectively (P > 0.05). Conclusions Compared with an open and a simple laparoscopic procedure, a hybrid procedure is more effective and safer in the repair of giant ventral hernias.

The case of surgical treatment of a giant ventral hernia complicated by postoperative abdominal compartment syndrome Pavlov University

The observation from practice is devoted to the surgical treatment of a giant ventral hernia complicated by postoperative abdominal compartment syndrome, acute intestinal obstruction and subtotal mesenterial thrombosis.

Giant Ventral Hernia in a Pregnant Patient

Large abdominal wall defects can occur as a result of temporary abdominal closure (TAC). TAC is used in critically ill patients where the abdominal wall cannot be closed due to intraabdominal hypertension, loss of domain (LOD), and other devastating abdominal conditions. Clinically, TAC is similar to giant ventral hernias (GVH) in that both have large facial defects. In the setting of pregnancy GVH is uncommon. In a meta-analysis of pregnant patients only five ventral hernias were described among nearly 33,000 patients [1]. Similarly, pregnancy in the setting of TAC is exceptionally rare. Our review of the literature did not identify other cases of TAC followed by a pregnancy. The literature does contain one case in which a pregnant woman suffered abdominal trauma and was managed with TAC [2]. In this report, we present the case of a woman who sustained penetrating abdominal trauma, received treatment with TAC, failed to return to clinic, then subsequently re-presented with a second trimester gestation.