Hernias in the lower abdominal wall can be challenging to repair. Why? Surgeons may need to dissect the bladder without injuring it, and there is a lack of places to safely fix the mesh.
The hypogastric hernia is one of those types of difficult hernias, as well as Pfannenstiel incisional hernia. The latter one is rare but has the additional difficulty of adhesions which increase the risk of viscera injuries. Although rare all surgeons must be prepared to repair a Pfannenstiel incisional hernia. Hernia surgery must not be underestimated as some surgeons like to think. Remember that an appropriate hernia repair can be very difficult to achieve and can be harder than several other procedures, including oncologic resections.
Recently, a female patient came to me with episodic low abdominal pain and a bump in the right lateral aspect of a Pfannenstiel incision (cesarean delivery and hysterectomy). She was diagnosed with a Pfannenstiel incisional hernia. A CT scan was performed, and a laparoscopic repair was scheduled.
The following video reports the laparoscopic repair of that Pfannenstiel incisional hernia by means of an IPOM+ technique. The bladder was dissected and its integrity was tested in the end. The patient was discharged home the day after. Three months later she was doing well, with no pain and no hernia.
Do you enjoy adrenal surgery? Must have this new book!
Costa Almeida CE, editor. Posterior Retroperitoneoscopic Adrenalectomy. Indications, Technical Steps and Outcomes. Switzerland: Springer; 2023.
Link to video:
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Enjoy.
Dr. Carlos Eduardo Costa Almeida
General Surgeon