Laparoscopic ventral hernioplasty in an adolescent with multiple epigastric hernias: A case report

Abstract

Background: Epigastric hernias account for 4% of abdominal wall defects in children. They present as a painless or tender mass at the supraumbilical midline. Their coventional treatment in children is open herniorrhaphy without the use of meshes. The management of the infrequent cases of multiple epigastric hernias can be challenging, and requires careful consideration to ensure optimal repair that minimizes tissue tearing. Case presentation: We present a case involving an obese adolescent with Down syndrome who experienced abdominal discomfort associated with a mass in the ventral abdominal wall. Ultrasound examination and laparoscopy revealed a total of six epigastric defects. The decision was made to perform a longitudinal plication of the ends of the linea alba using a laparoscopic technique to avoid the manipulation of each defect separately. In addition, a composite intraperitoneal mesh (IPOM) with a hydrogel layer on its visceral side was placed. To our knowledge, this technique has not been previously applied in this clinical context. The postoperative course was uneventful, with no significant pain, seroma, or wound complications. At the 18-month follow-up, the patient remained asymptomatic, showing no evidence of recurrence, and was able to perform regular physical activity. Conclusion: The use of laparoscopic defect suture closure combined with IPOM repair is a minimally invasive, and cosmetically and functionally acceptable method for the repair of multiple epigastric hernias in carefully selected pediatric patients, with good short- and medium-term results.

Keywords

• Epigastric hernia
• Laparoscopic surgery
• Intraperitoneal mesh repair
• Case report