PMC7315276_01
A 5 cm vertical surgical scar is present distal to the umbilicus. Significant midline abdominal bulging is noted to extend beyond the level of the scar.
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The abdomen bulged outward from the level of the lower sternum to below the umbilical fossa (Figure 1), and a 15 cm separation of rectus abdominis was palpated both above and below the umbilical fossa.
Preoperative abdominal computed tomography: (a) 3 cm above the superior border of the umbilicus; (b) center of the umbilicus; (c) 2 cm below the inferior border of the umbilicus. The inter-rectus distance is indicated by a white line.
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The inter-recti distance (IRD) was 36 mm at 3 cm above the superior border of the umbilicus, 40 mm at the center of the umbilicus, and 36 mm at 2 cm below the inferior border of the umbilicus (Figure 2).
Intraoperative photographs. (a) The rectus abdominis muscle is displaced to the left and right. The peritoneum is intact. (b) The anterior rectus muscle is sutured. (c) A mesh is applied to the rectus abdominal muscle. (d) Excess skin is removed in a spindle shape. (e) Closure of the incision.
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A spindle-shaped incision was used to excise this tissue, with the spindle measuring 15 cm in the horizontal direction (Figure 3).
(a-c) Postoperative abdominal computed tomography. (a) 3 cm above the superior border of the umbilicus; (b) center of the umbilicus; (c) 2 cm below the inferior border of the umbilicus. There is no apparent recurrence of the hernia. (d-e) Appearance three months after surgery. The patient's abdominal bulge has resolved.
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The patient is satisfied with her abdominal appearance (Figure 4).