Median Umbilical Ligament Flap Cover for an Exposed Mesh : An Interesting Case Report
Premkumar Balachandran
Institute of Hernia Surgery & Abdominal Wall Reconstruction, Apollo Hospitals, Chennai, Tamilnadu, India.
Vishanth Gubendran *
Institute of Hernia Surgery & Abdominal Wall Reconstruction, Apollo Hospitals, Chennai, Tamilnadu, India.
Adhiyaman Manimaran
Department of General Surgery, Apollo Speciality Hospitals, OMR, Chennai, Tamilnadu, India.
Kanchan Pankaj Waykole
Institute of Hernia Surgery & Abdominal Wall Reconstruction, Apollo Hospitals, Chennai, Tamilnadu, India and Mansarovar medical college, Sehore, India.
Anushka Somasundaram
Department of General Surgery, Apollo Speciality Hospitals, OMR, Chennai, Tamilnadu, India.
*Author to whom correspondence should be addressed.
Abstract
Aim: Our aim is to highlight the alternative methods to cover an exposed mesh due to lack of peritoneum secondary to the mesh related complications following a transabdominal pre-peritoneal inguinal hernia repair.
Case Presentation: An elderly male presented with the symptoms of subacute intestinal obstruction following a laparoscopic transabdominal pre-peritoneal right inguinal repair a month ago. CT scan with oral contrast of the whole abdomen showed low-grade partial mechanical small bowel obstruction secondary to adhesions of the mesh.
Discussion: Mesh reinforcement is generally considered the standard of care in hernia repair. Infection is a known complication following hernia repair. Modifiable risk factors for mesh infections include active smoking, poorly controlled diabetes mellitus, abdominal skin or wound issues, and obesity. Operative factors that increase the risk of mesh infection include prior hernia repair, enterotomy and contamination of the surgical field. It is important to completely close the peritoneum when placing the mesh. There are various methods available for mesh cover such as primary peritoneal closure, omental flap, prosthetic mesh and median umbilical ligament flap. Here, we report our experience with a patient presenting with subacute intestinal obstruction, following transabdominal pre-peritoneal inguinal hernia repair.
Conclusion: Among all the above mentioned methods,the median umbilical ligament flap is the ideal choice in our case by providing a natural, autologous tissue option and potentially reducing the risk of complications.
Keywords: Transabdominal pre-peritoneal repair (TAPP), totally extra-peritoneal repair (TEP), subacute intestinal obstruction (SAIO), median umbilical ligament (MUL)