POSTOPERATIVE INTERSTITIAL HERNIA AFTER e-TEP CAUSING INTESTINAL OBSTRUCTION

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Abstract Introduction Interstitial or intraparietal hernias are those placed between the two layers of the abdominal wall. They are rare and can be congenital or acquired. One of the presentations can be as bowel obstruction. Material and Method We present a case of a 71 caucasian male with primary ventral hernias and diastasis recti operated by laparoscopy performing a total extraperitoneal e-TEP with a retromuscular polipropilene mesh. The 4th postoperative day he complained with nausea and vomiting. CT scan demonstrated a bowel obstruction with a small bowell loop adherent to the abdominal wall, but no hernia was demonstrated. Conservative treatment was tried without result. He was operated again 7 days after the first surgery by laparoscopy approach. An interstitial hernia with intestinal obstruction was confirmed with 1,4 m of small bowel in the abdominal wall. The hernia was reduced, and a suture was performed to close the defect. We present the video of both surgeries, the e-TEP and the interstitial hernia repair. Conclusion Even when the repair is extraperitoneal, the tension created with the closure of the posterior fascia can lead to a small hole where a loop of small intestine can pass creating the interstitial hernia. This is a diagnostic we need to have in mind and, when a postoperative obstruction is not rapidly solved, we have to re-operate the patient.

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