The THT (Trentino Hernia Team) Technique Stands Out as a Reproducible and Highly Effective Option for Repairing Incisional Hernias

Abstract Background A 37-year-old woman, with a BMI of 27, underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAHBSO) three years ago through a midline incision. She presented with intermittent bloating and abdominal pain, accompanied by a protruding mass near her umbilicus. A CT scan confirmed the presence of an incisional hernia in the umbilical region, with herniated bowel. The treatment plan involved hernia repair surgery using the Trentino Hernia Team Technique, which included the development of the retromuscular space and insertion of a mesh. Method The procedure began with the insertion of optical and working ports on the left side of the abdomen. A diagnostic laparoscopy was performed, revealing dense and extensive adhesions, which were then lysed laparoscopically. Subsequently, the umbilicus was incised, and the anterior rectus sheath was also incised to access the retrorectus space. Blunt dissection of this space was carried out on all sides. The two rectus sheaths were stapled together cranially and caudally. A single port was placed in the umbilicus to aid in further dissection of the retrorectus space, allowing accommodation for the 15 × 15 cm mesh. The mesh was then placed in the retrorectus space and secured using histoacryl glue. Finally, the anterior rectus sheath was closed primarily at the level of the umbilicus. Result The patient was hospitalized for a total of three days. There were no observed instances of seroma, hematoma, or necrosis in the umbilical area. Postoperative pain was minimal due to the laparoscopic nature of the procedure. Conclusion This approach provides a repair with minimal tension, facilitating the strengthening of the abdominal wall by reconstructing the linea alba. The application of a 15 × 15 cm mesh over the defect greatly diminishes the likelihood of recurrence. Moreover, the retrorectus placement of the mesh is preferable to intraperitoneal placement, particularly in cases of iPOM (intraperitoneal onlay mesh).