PubMed · 13496531
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J S BERGER, A LAIBSTAIN. 1957. Spigelian hernia.. https://pubmed.ncbi.nlm.nih.gov/13496531/
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Incisional hernia is a common long-term complication of abdominal surgery. Historically the open repair with or without mesh was the mainstay of treatment. However, many recently published laparoscopic repair studies have challenged surgeons to re-evaluate which technique provides the best short and long-term outcomes. A Medline search of all English-language literature was performed using the keywords 'incisional', 'ventral', 'hernia', 'laparoscopic', and 'open'. Further references were obtained by cross-referencing the bibliography in each paper. Current evidence suggests that the laparoscopic incisional hernia repair is the optimal surgical treatment. A laparoscopic repair appears to shorten hospital stay, decrease perioperative complication rates, and decrease recurrence rates. However, there is no randomized trial utilizing a standardized complication grading system making it difficult to draw a definitive conclusion as to which repair is best.
The aim of the present case report is to present the diagnostic and therapeutic challenge of intercostal incisional hernia. We report on a female patient with leftsided intercostal incisional hernia between the eleventh and twelfth rib due to preceding lumbar incision for tumor nephrectomy. Because of its infrequence, diagnosis was established late although simple clinical examination and ultrasound investigation displayed the hernia. At laparotomy, a 5x5 cm(2) fascial defect with a colonic sliding hernia was found. Hernia repair using permanent mesh reinforcement in the retromuscular position is described. Abdominal incisional hernia in the intercostal region is rare and therefore easily overlooked. As with other incisional hernias, the hernia repair using mesh implantation in the retromuscular region is technically feasible and represents the treatment of choice.