PMC5994712_01
Computed tomography visualized a 10-cm, horizontal fascial defect (arrows at both ends).
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Computed tomography (CT) visualized a 14 cm (longitudinal) x 10 cm (horizontal) fascial defect in the upper abdomen (Fig. 1).
(a) A non-absorbable monofilament thread (dotted line) was perpendicularly inserted into the abdominal cavity. (b) A suture passage device was inserted into the abdominal cavity for the other side and the thread (dotted line) was pulled out to the skin. (c) A suture passage device was subcutaneously inserted and passed anterior to the hernia sac. (d) The thread was caught and pulled through with the suture passage device. The threads were sequentially tied and the knots were buried under the skin.
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The schematic presentation of this percutaneous defect closure is shown in Fig. 2, i.e., a "square stitch."
(a) Intraabdominal view of the threads for percutaneous defect closure. The interval of each thread was approximately 2 cm. (b) A suture passage device was subcutaneously inserted and passed anterior to the hernia sac (arrow heads). (c) The threads were sequentially tied in a cranial to caudal direction. (d) The cranial-most limit of mesh fixation was at the level of the subcostal margin (arrowheads). (e) The remaining part of the mesh was draped over the liver surface without tacking (arrowheads).
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The interval between lines was approximately 2 cm (Fig. 3a). Subsequently, the suture passage device was subcutaneously inserted from the left edge of the line and was passed anterior to the hernia sac (Fig. 3b). Finally, the threads were sequentially tied in a cranial to caudal direction (Fig. 3c), and the knots were buried under the skin. The cranial limit of mesh fixation was at the level of the subcostal margin (Fig. 3d). The remaining part of the mesh was draped over the liver surface without tacking (Fig. 3e).
Follow-up computed tomography at 12 months after surgery. There was no radiographically significant seroma, mesh bulge, or hernia recurrence.
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CT was performed at 3 and 12 months (Fig. 4).