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Rare linea arcuate hernia following transversus abdominis release ventral hernia repair
Ian L. McCulloch; Cody L. Mullens; Kristen M. Hardy; Jon. S. Cardinal; Cristiane M. Ueno
West Virginia University
2018-02-06
Presenter: Cody L. Mullens
Affidavit:
I certify that the material proposed for presentation in this abstract has not been published in any scientific journal or previously presented at a major meeting. The submitting and presenting author of the work for this project has been predominately been accomplished through their efforts. He conceived and developed the majority of the study design with assistance of the faculty and resident co-authors, acquired most, analyzed all and interpreted all data and was responsible for the majority of drafting the abstract text with the assistance and guidance of the more senior authors on the abstract.
Director Name: Aaron C. Mason
Author Category: Medical Student
Presentation Category: Clinical
Abstract Category: General Reconstruction
The principles of ventral hernia repair are well understood. An innovative technique described by Novitsky et al in 2012 described a retrorectus abdominis separation of abdominal wall components coupled with the release of the transversus abdominis muscle laterally (TAR-PCS). Early reports attest to the versatility and low recurrence rate when using this method. However, given its novelty compared to more widely utilized techniques, the TAR-PCS has not extensively examined for potential pitfalls associated with this type of reconstruction, in particular the potential for herniation below the arcuate line (LAH). Extensive literature review revealed only nine previously described cases of symptomatic LAH none of which were in the setting of ventral hernia repair. Here, we present a case of LAH following TAR-PCS hernia repair in a 68-year-old female with a history of large B-cell lymphoma complicated by bowel perforation and emergency laparotomy. She subsequently developed an incisional hernia and underwent ventral hernia repair via the TAR-PCS procedure. Two weeks following repair, the patient experienced sudden onset nausea and abdominal wall discomfort which was misdiagnosed preoperatively as incisional hernia recurrence. Intraoperatively, LAH was visualized with herniation only caudal to the initial repair. We postulate that the quality of, and tension on the tissue below the arcuate line must be considered in the use of TAR-PCS. To avoid herniation below the arcuate line, the authors suggest the use of prosthetic mesh sutured to caudal anatomy in unfavorable conditions.
