Adhesive Complications in a Patient After Ventral Hernia IPOM Repair - Case 2

A 21-year-old male patient was referred to our department in January 2006 diagnosed with linea alba hernia and gastroesophageal reflux disease. Preoperative imaging studies (chest X-ray, X-ray of the upper alimentary tract, gastroscopy and abdominal ultrasound scan) showed no other abnormalities. Anti-reflux operation and IPOM procedure for ventral hernia were performed with the same technique as in the first case. The postoperative course was uneventful. From September 2008 he suffered similar pain as before the primary operation, but of a decreased intensity. He was readmitted to the hospital several times with subileus symptoms (mainly vomiting) and was treated conservatively. That is why he was qualified for a second-look diagnostic laparoscopy. He underwent the operation on 09.02.2009. Intraoperatively, numerous hard adhesions of the greater omentum and anterior stomach wall to the Dynamesh were seen. These adhesions were especially excessive in contact with Protack staples. Adhesions were released, however, because of the rigid infiltration of the frontal surface of the stomach; a part of the mesh was excised. This place was filled by further, overlapping Dynamesh (15 × 12 cm), positioned with the Endo Hernia stapler. The patient was discharged on the third postoperative day. During one-year follow-up he had four episodes of abdominal pain, lasting less than four hours and subsiding after relaxants.