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Transversus abdominis muscle release without mesh for incisional hernia in a patient with advanced pancreatic cancer (Case Report)

黒河内, 喬範 五十嵐, 陽介 田口, 恵理子 鈴木, 英之 中林, 幸夫 松田, 実 東京慈恵会医科大学

2021.03.10

概要

Background : Incisional hernias, frequent complications of abdominal surgery, are still a chal- lenge for surgeons. However, for incisional hernias in patients with advanced abdominal cancer, no definitive treatment has been established.

Case presentation : The patient was a 69-year-old woman in whom an incisional hernia devel- oped and frequently caused abdominal pain after gastrojejunostomy was performed for an unresect- able pancreatic cancer. The hernia was categorized as a complex hernia, with a maximum size of 35 × 30 mm and intermittent presence under the xiphoid process. Therefore, tissue-to-tissue repair with a posterior component separation technique and transversus abdominis muscle release was per- formed. With the presence of peritoneal dissemination, prosthetic repair was abandoned. The postop- erative course was uneventful, and the patient was discharged 10 days after surgery.

Conclusion : Although some controversies are involved in the treatment of incisional hernias in patients with end-stage cancer, fascial repair, such as transversus abdominis muscle release, appears to be effective for the treatment of complex hernias.
(Jikeikai Med J 2021 ; 68 : 9-14)

Key words : incisional hernia, transversus abdominis muscle release

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