Page 35 - Journal of Laparoscopic Surgery

WJOLS

Laparoscopic Repair of Non-midline Abdominal Wall Hernia
with swelling, five patients were having complete of another defect which was far laterally placed than
reducible swelling, six (46.15%) patients presented with original defect. One patient with a hernia at right hypo-
partially reducible swelling and only one patient (7.69%) gastrium had got defect at right iliac fossa and another
presented with non-reducible swelling. Mean duration patient with a hernia at right lower abdomen got defect
of symptoms were 30.15 months within a range of three of size 0.5 x 0.5 cm at the lateral border of rectus near the
months to hundred and eight months (Table 2). semilunar line which could be a Spigelian hernia. The
2
Among all patients (n = 13) six patients (46.15%) have average size of mesh used was of diameter of 140 cm. in
2
2
got associated comorbidities out of which two were suf- range of 120 cm –225 cm. Mean duration of operating
fering from hypothyroidism, one hypertension along time were 78.84 minutes (SD = 22.62) in range of 60 to
with hypothyroidism, one hypertension with dyslip- 120 minutes (Table 1).
idemia, one diabetes mellitus type–II and another one Out of total thirteen patients, five (38.40%) complained
having hypertension. Rest of the patients (53.84%) were mild to moderate pain while two (15.35%) had severe
not having any associated comorbidities. and prolonged pain postoperatively. One patient (7.69%)
Out of total 13, 8 patients (61.53%) have got history of developed acute retention of urine in the immediate
past surgery among which 5 (38.46%) were having lower post-operative period. Four patients (30.76%) developed
abdominal surgery [LSCS–2 (15.38%)], LSCS with open mild to moderate seroma, and one (7.69%) developed
appendicectomy–1 (07.69%), open appendicectomy–1 hematoma at hernia site postoperatively. All of these
(7.69%), lap. Oophorectomy –1(07.69%) and three (23.07%) resolved spontaneously within three months follow up
had history of upper abdominal surgery (lap. cholecys- period. Two patients (15.38%) has got cellulitis around 10
tectomy–1 (07.69%), small open epigastric hernia repair-1 mm port site with the consequent discharge of pus. Out
(07.69%), exploratory laparotomy for appendicular perfo- of these two patients, one (7.69%) had developed chronic
ration peritonitis-1(07.69%). Five (38.46%) patients were infected discharging sinus which ultimately required
not having any history of surgical intervention in the past. re-surgery and removal of mesh. Probably this was the
Among all operated cases, anatomical location of reason, recurrence of a hernia happened in this patient
a hernia in five cases (38.46%) were at lower part of only (Table 3).
abdomen (right lower hypogastrium and right iliac
fossa–3 (23.07%), left lower–2(15.38%), another five DISCUSSIONS
(38.46%) found to be on upper part of abdomen (right sub- Finding of only thirteen cases of non-midline ventral
costal and subxiphoid–1(07.69%), right upper abdomen–39 abdominal wall hernia during four years at tertiary care
(23.07%), left upper abdomen–1 (07.69%) and three teaching institute itself suggests that it is not a common
(23.07%) were on the line of umbilicus-left side–2 (15.38%), type of a hernia. Maybe this is the reason availability
right side–1 (07.69%). All the larger size hernias were of studies or reports in respect of a non-midline hernia
on the right lower abdomen. Out of thirteen patients, is very sparse and whatever literature available is of a
five (38.46%) were having tender swelling on physical limited number of series and sporadic case report.
1-3
examination. Shortage of literature is not only limited to research
As expected in non-midline or lateral hernias, size of
defects was of comparatively smaller diameter. Average
2
2
2
size of defect was 06.661 cm, (range of 2.5 cm –35 cm ). Table 3: Operative details including complications
The largest defect found in a patient with a large hernia Parameters Average / Range / % of total
patients
involving right subcostal and lumbar area. Intra-opera- Operative time (in minutes) 78.4 (60 – 120) S.D. = 22.62
tively, out of total thirteen patients two patient has finding Defect size Average = 6.661cm. 2
– Diameter Smallest (0.5 × 0.5) cm. /
– (vertical x horizontal) Largest (7 × 5) cm.
Table 2: Important clinical feature
Complications
Signs and Symptoms Percentage 1. Mild to moderate pain 38.40%
1. Swelling 2. Severe and prolonged 15.35%
Reducible 38.46 pain
Partially reducible 46.15 3. Acute retention of urine 07.69%
Non-reducible 07.69 4. Seroma 30.76%
2. Pain 38.46 5. Hematoma 07.69%
3. Anatomical location 6. Cellulitis 15.38%
Above the line of umbilicus 38.40 7. Discharge 15.38%
Around the line of umbilicus 38.40 8. Required mesh removal 07.69%
Below the line of umbilicus 23.07 9. Recurrence 07.69%
World Journal of Laparoscopic Surgery, May-August 2018;11(2):85-89 87