Linea Arcuate Hernia Following Transversus Abdominis Release Incisional Hernia Repair

Abstract

Open abdominal surgery continues to be most commonly complicated by postoperative herniation at the incision line. In 2012, Novitsky et al described a novel hernia repair technique that utilized a transversus abdominis release coupled with a posterior (retrorectus) component separation (TAR-PCS) of the ventral abdominal wall. Early reports attest to the versatility and low recurrence rate of this technique, particularly when repairing large and complex defects. We present a rare case of herniation below the linea arcuate (LAH) following repair via TAR-PCS. Given its novelty compared with more widely utilized techniques, literature review revealed less discussion regarding potential pitfalls associated with this type of reconstruction, in particular the potential for LAH. To date, only 9 cases of symptomatic LAH have been described, although 2 previously described “suprapubic” herniations following TAR-PCS may represent previously mischaracterized cases of this type of complication. Nonetheless, none of these reports were in the setting of ventral hernia repair.

Laparoscopic Repair of a Rare Abdominal Wall Deformity and Review of the Literature

“…An open exploratory procedure also risks unnecessarily weakening the rectus sheath and abdominal wall muscle, enlarging the defect and even resulting in an incisional hernia. Seven cases have been successfully repaired laparoscopically, five reinforced with preperitoneal mesh and one with underlay mesh [3,4]. A laparoscopic approach carries the advantage of confirming a diagnosis and allows fixation without the need to perform a laparotomy.…”

“…To the best of our knowledge, there have been only 19 prior cases of symptomatic LAH reported in the literature [1]. There has been an 11:8 female majority with a presenting age ranging between 39 and 79 years [1][2][3]. The symptoms at presentation are nonspecific abdominal pain and bulging.…”

Single-incision laparoscopic repair for an arcuate line hernia: a case report

“…Unexpectedly, the ratio of men to women was 8:11; slightly more women than men. Three cases occurred after abdominal surgery and were diagnosed as incisional hernias, but were diagnosed as ALH intraoperatively [ 4 , 15 , 16 ]. As previously mentioned, ALH is considered less likely to cause symptoms because of the wide hernia orifice; however, there have been cases of emergency surgery owing to incarceration [ 6 , 9 , 13 ].…”