Management of a Central Recurrence After a Posterior Component Separation Repair in a Giant Subcostal Hernia

Abstract Aim Central recurrences after posterior component separation due to mesh failure are exceptional. We present our approach to solve this complex situation. Material and Methods 59 years old male patient with previous diabetes type II and arterial hypertension. He underwent an open cholecystectomy due to a septic shock secondary to a perforated acute cholecystitis. Wound infection in the po period. After one year follow-up he developed a giant subcostal hernia with a 15 × 20 cm defect. We repaired this incisional hernia with a Madrid posterior component separation with a double mesh technique. After 18 months follow up the patient developed a central recurrence, so a new surgery was proposed. A new preperitoneal retromuscular dissection was performed, creating a new preperitoneal pouch to locate a new absorbable + permanent 25 × 30 meshes. The disrupted previous mesh was partially removed and closed above the new meshes. Results No immediate postoperative complications. Discharged in the third postoperative day without any complications. No recurrence after 18-month follow-up. Conclusion Central recurrences following the failure of a Madrid posterior component separation repairs can be managed with the re-dissection of the preperitoneal retromuscular space.