LAPAROSCOPIC eTEP IN ACQUIRED ABDOMINAL INTERCOSTAL HERNIA WITH PERITONEAL FLAP WITH LARGE POLYPROPELENE MESH PLACEMENT

Abstract An 83-year-old Male patient presented with complaints of Swelling in the right lower chest, Right Hypochondrium and Right lumbar region. H/O – Chronic Cough for 6 months. Swelling increases in size on coughing. USG S/O – Right Lateral Ventral Hernia (L1 W2). CT Abdomen S/O – 8x6 cm defect in right anterolateral abdominal wall. Plan – Laparoscopic E-TEP with unilateral TAR Hernioplasty. Port position. Intraop Steps Supine position under General Anesthesia. Extended Retro-rectus space created from left side. Bottoms-up right-sided TAR done. Opening of peritoneum found near defect. A defect was identified between the right three lower ribs, with 1 rib being the content of the hernia. Evidence of Diaphragmatic hernia was seen. Thoracic contents visualised from the hernia defect. Hence, the diagnosis of acquired abdominal inter-coastal hernia was confirmed. Omentum & Transverse Colon were also contents of the hernia. The peritoneal Flap surrounding the defect raised superiorly till the Diaphragm, laterally to Gerota’s Fascia. Peritoneal Flaps were under tension, so the decision was taken to utilise the peritoneum flap of the hernial sac, and accordingly, peritoneal flaps were mobilised. Diaphragmatic hernia defect sutured with non-absorbable barbed sutures. Peritoneal defect approximated with absorbable barbed suture. 30 × 25 cm Polypropylene mesh placed in pre-peritoneal space. Mesh fixed to the edge of the defect. Pneumo pre-peritoneum deflated. Ports sites closed and strapping done post op. Post-operative recovery was uneventful, with a stay in the ICU for 3 days. Discharged on 7th day post op.