A hybrid laparoscopic technique for the treatment of large postoperative subcostal hernia: a clinical case report

Bulgarian Medical Journal, 2024, 18(3), 52-57.

A. Arabadzhiev

Clinic of Surgery, University Hospital for Active Treatment “Alexandrovska”, Department of Surgery, Medical University – Sofia, Bulgaria

Abstract. Introduction: Postoperative hernias of the abdominal wall are seen frequently after open surgery. The size of the hernial defect can sometimes reach significant dimensions, disrupting the quality of life of patients and leading to disturbances in the functions of the herniated organs. The only approved treatment for a diagnosed incisional hernia is surgery. Laparoscopic treatment of postoperative hernias is challenging for the surgeon, but enjoys all the benefits of a minimally invasive approach. Clinical case: A 71-year-old man was admitted to the Surgery Clinic with complaints of swelling, heaviness and discomfort in the area of the right lower rib. The patient reported having undergone a cholecystectomy in the past, a Kocher subcostal incision was observed on examination. Objectively, an incisional hernia is established in the area of the previous surgical intervention, which is multi-chambered and the size of the hernial defect is about 15-20 cm/d. The patient underwent laparoscopic plastic surgery with percutaneous closure of the defect and insertion of a two-component prosthesis. The patient’s postoperative period was uneventful, with no seroma formation, bulging of the prosthesis, or recurrence at one- year follow-up. Conclusion: Laparoscopic treatment of postoperative hernias of the anterior abdominal wall is achievable, but with increased difficulty due to the formation of postoperative adhesions from open surgery, which necessitates performing adhesiolysis. The method is feasible and can be considered as an option in the treatment of incisional hernias.

Key words: incisional hernia, subcostal region, laparoscopic surgery, percutaneous raffia, defect closure

Address for correspondence: Angel Arabadzhiev, MD, е-mail: a.arabadzhiev@medfac.mu-sofia.bg