Lateral bulging in the old surgical site
The clinical examination revealed a defect measuring approximately 10 x 15 cm a bulging, which was prominent in the standing position.
Flat belly in lying position
However, in the lying position, the swelling was hardly visible.
CT scan to confirm lateral hernia
The preoperative CT scan confirmed the presence of an incisional hernia in the old surgical site with a defect width of 11.5 cm.
Pre-treatment with Botox
Four weeks before the operation, 150 units of Botox were injected into the oblique abdominal wall muscles on the right side.
Lateral positioning for surgery
In preparation for the operation, the patient was positioned on his left side in a vacuum mattress for better exposure.
Intraoperative hernia size of 18 x 8 cm width
Intraoperatively, after preparation of the hernia sac, the defect measured 18 cm in the oblique craniocaudal and 8 cm in the lateral direction.
Preparing the preperitoneal space
After opening the hernia sac, bowel loops were seen without any adhesions. The preperitoneal space was widely dissected in all directions from the edges of the hernia sac.
Preperitonial placement of the mesh
A 35 x 30 cm PVDF mesh was now inserted into the large preperitoneal cavity. In addition, two 14mm redon drainage tubes are inserted.
Transmuscular placement of the pulling sutures
On each side of the defect, 6 USP 2 vicryl sutures were inserted transmuscularly passing through the external oblique muscle and the internal oblique muscle using a U-stich technique. These are then crossed and fixed in the clamps of the suture retention frame of the fasciotens®Hernia device under a pretraction of 14 Units (approx. 14 kg).
Increasing the traction forces gradually
After every 2 minutes, the sutures were retightened manually and each individually. Next, the traction forces were gradually increased to 18 Units (approx. 18 kg) by turning the hand wheel of the traction controller. After 20 minutes, no further stretching of the muscles could be achieved and the defect edges were fully adapted.
Closing the abdominal wall
The internal oblique muscle, the internal oblique muscle and the external aponeurosis are closed using slowly absorbable PDS sutures.
No stay in ICU needed
The postoperative course was without any complications. A stay in the intensive care unit was not necessary. The pain was successfully managed via an epidural catheter for 4 days and subsequently with Metamizole. The patient was discharged on the 5th postoperative day.
Cosmetic results
