Key points are not available for this paper at this time.
Abstract Aims One of the main mid- and long-term complications after abdominal surgery is the occurrence of an eventration. The minimally invasive approach (MIS) to midline hernias currently one of the least used techniques in the emergency department. One of the great advantages of the laparoscopic approach to a strangulated ventral hernia (VH) is to be able to adequately assess the viability of the intestinal loops. The use of ICG can help to objectively assess adequate intestinal blood supply. Methods A 72-year-old woman with previous umbilical hernia operation, BMI: 44. Came to the ER with abdominal pain related to umbilical prolapse. CT-showed a diastasis of the rectum and a VH of approximately 4 cm containing a distal ileum loop with signs of distress in the hernial sac and the loops with liquid at that level. Results We observe a VH with dilated bowel loops and distressing fluid inside which is reduced with atraumatic maneuvers and graspers. A midline V-H is identified with a 4 × 5 cm defect (M3W1). Direct closure of the defect was performed with a non-absorbable barbed suture. Adhesiolysis and then a PVDF mesh is placed and fixed with absorbable tacker and cyanoacrylate glue. Affected intestinal loop is identified and fluorescence angiography with ICG is performed to confirm the adequate viability of the intestinal loops. Conclusions We believe that MIS to abdominal wall complications in the emergency setting is feasible and provides the advantages of laparoscopy in addition to being able to explore the abdominal cavity with support of ICG.
Licardie et al. (Wed,) studied this question.