Transfascial Suture Hernia: A Rare Form of Recurrence After Laparoscopic Ventral Hernia Repair

Abstract

Laparoscopic repair of ventral or incisional hernia is among the most commonly performed minimally invasive procedures. Different modes of recurrence have been reported in literature, including missed defects, mesh migration, mesh infection, etc. Transfascial suture fixation in addition to tackers is an established method to prevent recurrence due to mesh migration. We report possibly the third case of recurrent ventral hernia with multiple defects at transfascial suture sites of previous laparoscopic ventral hernia mesh repair. The patient was treated by laparoscopy with a large intraperitoneal PROCEED mesh, covering the new hernia defects and older mesh.

Techniques of mesh fixation in laparoscopic ventral hernia repair: the surgical enigma - a review

“…[25][26][27]31,49 Although two case reports were found, which reported post-operative hernia through trans fascial suture hole, which was considered more as a situational and technical fault rather than of the technique itself. 37,38 Among the all reviewed article scanned here, only four reports (one RCT, one case control study, one case series and one review article) were found to have result in direct favor of tacker fixation of mesh in laparoscopic ventral hernia repair. [41][42][43][44] Two other reports (one prospective study and another review article) find no difference in recurrence rate and other surgical outcome.…”

“…36 In contrast to some serious complications reported with use of tacks, only few cases of hernia through trans-fascial suture site has been reported and attributed probably to technical error. 37,38 This is the reason why, even today majority of surgeons along with tacks fixation, use four corner trans fascial suturing.…”

“…[7][8][9][12][13][14][15]30,35,39,40,41,44,45,47,48 We found seven relevant case reports also, most of which reported either some unusual complications due to particular mesh fixation technique or some innovative idea of mesh fixation technique. 17,19,26,27,37,38,49 A few prospective cohort and case control studies also found to be very helpful. 28,31,34,42,46,47 Rest of the studies, most of which were done at experimental level on animals included an attempt to evaluate newer technique of mesh fixation e.g.-fibrin sealant, tissue glue, Laser fixation etc.…”

Transfascial suture in laparoscopic ventral hernia repair; friend or foe?

“…in 2010. [ 5 ] They described a case of recurrent incision hernia following LVHR. Laparoscopy revealed multiple hernial defects along caudal border of the mesh, where transfascial sutures were applied.…”

“…Very few cases of hernia at the fixation site, either using suture or tacks, have been reported. [ 4 5 6 ] We hereby report an extremely rare case of ‘suture hernia’, which occurred following laparoscopic umbilical hernia repair with transfascial fixation of mesh. This type of hernia is 4 th reported case of its type and second from our institution.…”