A SURGICAL CHALLENGE IN THE REPAIR OF INFRAUMBILICAL INCISIONAL HERNIAS

Abstract

Background: Incisional hernia (IH) is one of abdominal surgery's most prevalent postoperative complications. Its recurrence rate is still high despite the many techniques and procedures described for repairing IH and its prevention. The management of IH requires knowledge and expertise to reduce the high rates of postoperative complications and recurrence. The diversity and complexity of IH may force the hernia surgeon to individualize the treatment because it seems that. The aim of the study is the surgical challenge in the repair of infraumbilical incisional hernias. Case report: The patient, a 51-year-old woman, had an infraumbilical edema. She had a scar in the midline of the infraumbilical region from tubal ligation (Figure 1). She experienced swelling in the infraumbilical region 15.18 months ago, which grew larger and became intractable. She described her history of suffering in this area. No further grievances were raised.1-0 Vicryl was used to seal the peritoneal layer. On either side of the midline, a gap was formed between the layer of muscle and the aponeurosis that covered it. Interrupted 1-0 Vicryl sutures were used to approximate the rectus muscle to the midline. Over the muscle layer, a polypropylene mesh was positioned and secured. After being positioned over the mesh's surface, the negative suction drain was removed via a different incision. Horizontal mattress sutures without any polypropylene sutures were used to approach the aponeurotic layer. On the twelfth postoperative day, skin staples were taken out. The post-operative period went smoothly. For the past three months, the patient has been monitored with no signs of a recurrence or related symptoms.

Conclusion: Due to the physical lack of strong musculo-aponeurotic components in the area, infraumbilical incarcerated incisional hernias present the greatest surgical challenge. Due to the hernia's complete irreducibility, a laparoscopic procedure is deferred. The safest method is the open approach, notwithstanding its technological difficulties. This involves making room for a mesh to be placed between the aponeurosis and the muscle layer. This prevents all of the issues associated with the onlay technique as well as the peritoneal penetration of an inlay procedure.