Laparoscopic Intraperitoneal Onlay Mesh (IPOM) “Swiss Cheese” Ventral Incisional Hernia Repair with Urinary Bladder Mobilization: A Case Report

Patient: Female, 57-year-old Final Diagnosis: Incisional hernia treatment • swiss cheese hernia treatment Symptoms: Abdominal pain Medication:— Clinical Procedure: Parietal Surgery procedure Specialty: Surgery OBJECTIVE: Rare coexistence of disease or pathology BACKGROUND: Incisional hernias (IH) are a common problem worldwide. The development of IH is influenced by factors related to the patient, the operative technique, and the suture material. In the treatment of ventral incisional hernias, laparoscopic IPOM and open sublay mesh repair are the most common techniques used for primary and recurrent hernias, with comparable short- and long-term outcomes. CASE REPORT: We report a case of a pubo-umbilical “swiss cheese” IH treated by laparoscopy with the placement of a nonresorbable mesh in intraperitoneal position. The urinary bladder was mobilized for a convenient mesh fixation and sutured to the mesh in the previous anatomical position, at the level of the upper peritoneal layer. “Swiss cheese” hernia is a particular form of IH, characterized by the presence of multiple small defects. Laparoscopic intraperitoneal onlay mesh (IPOM) IH repair for defects under 10 cm is a reliable alternative to open ventral hernia repair. Transfascial sutures represent a simple solution for the defect closure and are associated with lower incidence of seroma and recurrence. The use of a mesh allows improving the muscle functionality and preventing hernia recurrence and also is associated with reduced recurrence rates compared to primary suture repair and additionally provides superior mechanical stability. CONCLUSIONS: In case of pubo-umbilical medial “swiss cheese” IH, mobilization of the urinary bladder is necessary and allows a complete abdominal wall approximation and convenient mesh placement.