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Abstract A 73-year-old female with history of diabetes mellitus and hepatic transplant presents with discomfort in a reducible 10 cm M1M2W3 incisional hernia. Botulinum Toxin was injected 4 weeks prior to the surgery in order to achieve the medialization of both rectus muscles without tension avoiding the need to do a posterior component separation. The patient is operated using a full endoscopic minimally invasive extraperitoneal approach (e-TEP). A 2 cm incision on the left subcostal region is made, exposing and opening the anterior rectal sheath (ARS), medializing the left rectus muscle. A dissection balloon is introduced to release the retromuscular space. Two more trocars are inserted in the left hypochondrium and left iliac fossa (10 mm, 5 mm respectively). We then proceed to incise the medial aspect of the left posterior rectus sheath (PRS) and start the preperitoneal dissection doing the crossover above the umbilicus. Cranially, we carefully section the adhesions of the old laparotomy to connect the preperitoneal space with the retrodiaphragm space bilaterally to not only correct the defect but to also enforce the laparotomy scar. The hernia is then reduced and the defect is closed with a barbed suture. A wide pore PPL mesh is inserted, covering both retrodiaphragm and preperitoneal spaces. The mesh is fixated. A drainage is placed and removed 24 h after surgery. The patient is discharged 24 h after without complications. In the CT scan 6 months after surgery the correction of the defect was confirmed and pain and aesthetic results where satisfactory.
Luque et al. (Wed,) studied this question.