PMC6664569_01
Preoperative marking of the subcostal margin (marked a), hernia defect (b), and the linea semilunaris (c).
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Physical examination showed a supra- and infraumbilical incisional hernia with a periumbilical midline scar (Figure 1).
Postoperative photograph of Case no. 1 showing the port incisions.
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She had an uneventful postoperative recovery and was discharged on the 4th postoperative day (Figure 2).
PMC6664569_02
CECT of Case no. 2 showing the subcostal defect (arrow).
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She was subjected to a contrast-enhanced computed tomography of the abdomen, which showed the hernias: right subcostal hernia measuring 6 x 6 cm and the infraumbilical port-site hernia about 4 x 4 cm in size (Figures 3 and 4).
CECT of Case no. 2 showing the infraumbilical port site hernial defect (arrow).
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fig4
She was subjected to a contrast-enhanced computed tomography of the abdomen, which showed the hernias: right subcostal hernia measuring 6 x 6 cm and the infraumbilical port-site hernia about 4 x 4 cm in size (Figures 3 and 4).
Intraoperative photograph of Case no. 2 showing the defect (marked a), the ipsilateral (left) rectus muscle (b), and the posterior rectus sheath of the ipsilateral (left) side (c) visible after retrorectus dissection.
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fig5
In June 2018, we did a retrorectal Rives-Stoppa repair with right-sided transversus abdominis release (TAR) following the principles of Belyansky et al. (Figures 5-7).
Intraoperative photograph of Case no. 2 showing the right costal margin (marked a), neurovascular bundle at the right linea semilunaris (b), and the division of the right-sided transversus abdominis muscle (c).
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In June 2018, we did a retrorectal Rives-Stoppa repair with right-sided transversus abdominis release (TAR) following the principles of Belyansky et al. (Figures 5-7).
After TAR, visualization the lateral edge of divided transverse abdominis (TA) fibers (marked a), medial edge of divided TA fibers (b), costal margin (c), horizontal fibers of the diaphragm (d), the transversus abdominis muscle (labelled TA), and the retromuscular space (e).
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fig7
In June 2018, we did a retrorectal Rives-Stoppa repair with right-sided transversus abdominis release (TAR) following the principles of Belyansky et al. (Figures 5-7).
Closure of the posterior rectus sheath and the peritoneum (arrow).
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fig8
After reduction of the hernia, the hernia defects were approximated with no. 1 polypropylene, the peritoneum was opposed with 2-0 polygalactin continuous (Figure 8), and retromuscular polypropylene mesh was placed (Figure 9).
Placement and unrolling of the polypropylene mesh in the preperitoneal (retrorectus/retromuscular) space.
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After reduction of the hernia, the hernia defects were approximated with no. 1 polypropylene, the peritoneum was opposed with 2-0 polygalactin continuous (Figure 8), and retromuscular polypropylene mesh was placed (Figure 9).
PMC6664569_03
CECT of Case no. 3 showing the previously placed radiopaque displaced e-PTFE mesh placed intraperitoneally as IPOM (arrow).
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A preoperative computed tomography scan showed the hernia with the same dimensions along with the radiopaque e-PTFE layer mesh (Figures 10 and 11).
CECT of Case no. 3 showing the epigastric defect (arrow) along with part of a previous mesh.
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A preoperative computed tomography scan showed the hernia with the same dimensions along with the radiopaque e-PTFE layer mesh (Figures 10 and 11).
Removed e-PTFE mesh from Case no. 3.
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In August 2018, we did laparoscopic Rives-Stoppa repair, the removal of the previous mesh with a placement of the retrorectal polypropylene mesh (Figure 12).
CECT of Case no. 3 showing large collection developed in the retrorectus space (arrow).
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He developed a collection detected after 5 days, which started increasing (Figure 13); so we put a drain on the 10th day; about 600 ml of serosanguinous fluid that came out the drain was kept for 8 days more after which it was removed.