CASE PRESENTATION
A middle aged female presented to us with abdominal wall swelling for last 8 years, now associated with increasing pain for last 3 months. She earlier had underwent Explorative laparotomy for Intestinal perforation followed by wound dehiscence 12 years back. On clinical examination, she was found to have multiple swiss cheese pattern defects in midline from epigastrium to supra-pubic region with bowel loop as contents in multiple hernia defects. She was optimised medically and investigated with CECT Abdomen to assess abdominal musculature and hernia anatomy in detail. CT scan was suggestive of bowel loops being content of hernia defects with possible adhesions with anterior abdominal wall. After pre-operative optimization, she was planned for Robotic Abdominal wall Reconstruction (e-TEP-RS +-TAR).
DIAGNOSIS
Complex Ventral hernia (Incisional, Irreducible, Bowel as content, M1-5)
MANAGEMENT
Patient underwent Robotic Abdominal Wall Reconstruction (eTEP-RS) for Complex Ventral Hernia
OUTCOME AND FOLLOW UP
Patient tolerated the procedure well and surgery went uneventful. She was ambulated 4 hours after the surgery and discharge from the hospital on 2nd post-operative day. Her follow up at 1 week and 1 month was satisfactory.
DISCUSSION
Abdominal wall Reconstruction (AWR) is Advanced Hernia Surgery which is gaining popularity in recent times, especially in complex abdominal wall hernias. It is different from Laparoscopic IPOM Ventral hernioplasty where mesh inspite of being placed in the peritoneal cavity, is placed between the abdominal wall layers. This prevent usage of costly composite meshes and Tacking devices used in Laparoscopic IPOM. Thus implant cost involved in AWR is much less compared to Laparoscopic IPOM Ventral Hernia Surgery. Post-operative pain is less and recovery is much faster in AWR, but it requires a surgeon’s learning curve due to its complexity.
Surgical Robot makes AWR surgery easier as instrument maneuverability is better while working in closed space and surgeon’s fatigability is less being long surgeries. Further benefit of Surgical Robot is better precision, more safety, less blood loss and early recovery for the patient. An increasing number of surgeons are turning towards Robotic or Laparoscopic Abdominal Wall Reconstruction technique to repair complex hernias, as it offers improved surgical outcomes as opposed to conventional open surgical method.
