For patients who have previously undergone ventral hernia repair with synthetic mesh, options are limited once they represent with infected mesh. Removal of the mesh leaves a significant defect. Bridging fascial defects with biologic mesh tend to have higher recurrences than using biologics in an underlay fashion. Open separation of components is an option for these patients. However wound complications are frequent. We present a video of a 49 y/o male with multiply recurrent incisional hernia and infected mesh that underwent repair by means of a laparoscopic component separation.
Case: The patient is a 49 year old caucasian male with a history of diabetes mellitus, morbid obesity, hypertension and tobacco use who developed an incisional hernia following exploratory laparotomy for trauma 10 years prior. He has undergone two incisional hernia repairs with polypropylene mesh. For the last three years he has had recurrent abdominal wall abscesses which have required incisions and debridement, partial mesh excisions, and chronic antibiotic use. We performed an incisional hernia repair, removal of infected mesh and a laparoscopic component separation. Porcine dermal collagen mesh was utilized in an underlay fashion. The fascia was closed over the mesh. There were no intraoperative complications. The patient was discharge on postoperative day 4 without evidence of wound complications. At two week follow up, one of the 2 drains were removed. His wound was healing nicely without evidence of necrosis or infection.
Conclusion: Laparoscopic component separation is a useful adjunct to incisional hernia repair that may avoid the wound complications associated with the open technique.