Successful Laparoscopic IPOM Plus Repair for Symptomatic Incisional Hernia in a 51-Y.O Female

PACE Hospitals

PACE Hospitals’ expert Surgical Gastroenterology team successfully performed a Laparoscopic Intraperitoneal Onlay Mesh (IPOM) plus procedure on a 51-year-old female patient diagnosed with an incisional hernia. The aim of the procedure was to repair the hernia defect securely, reinforce the abdominal wall with mesh placement, minimise the risk of recurrence, and improve the patient’s overall abdominal function.

Chief Complaints

A 51-year-old female patient with a body mass index (BMI) of 21 presented to the Surgical Gastroenterology Department at PACE Hospitals, Hitech City, Hyderabad, with complaints of swelling and pain at the site of a previous surgical port.

Past Medical History

The patient has a history of a laparoscopic hysterectomy and is a known case of hypertension, which is well-controlled with regular antihypertensive medications.

On Examination

On examination, the patient was conscious, oriented, and cooperative. Local examination at the previous port site revealed no visible swelling or bulge, but mild tenderness was noted on palpation in the left upper quadrant, corresponding to the area of reported pain. The pain was localized without signs of spreading or inflammation. There was no redness, warmth, or discharge suggestive of infection, and no palpable hernia defect or mass. Bowel sounds were normal, and the rest of the systemic examination was unremarkable.

Diagnosis

Upon admission, the patient underwent a comprehensive clinical evaluation, along with a detailed review of her prior medical records and diagnostic reports by the surgical Gastroenterology team.

To support clinical findings, laboratory and special investigations were carried out as part of the preoperative assessment. Complete blood count (CBC) was within normal limits, with no evidence of leukocytosis or anemia. Liver function tests (LFTs) and renal function tests (RFTs) were normal, indicating no hepatic or renal dysfunction. Serum electrolytes and coagulation profile, including PT, INR, and APTT, were also within normal limits, suggesting no bleeding risk.

Imaging studies included an abdominal ultrasound, which revealed a defect at the previous laparoscopic port site consistent with an incisional hernia. A contrast-enhanced CT scan of the abdomen and pelvis further confirmed the presence of a 1 cm hernia defect with omental adhesions but no signs of bowel obstruction or strangulation. These findings supported the diagnosis and proper management.

Based on the confirmed diagnosis, the patient was advised to undergo Incisional Hernia Treatment in Hyderabad, India, under the expert care of the surgical Gastroenterology Department.

Medical Decision Making

After a detailed consultation with Dr. Suresh Kumar S, a Surgical Gastroenterologist, a comprehensive evaluation was carried out to determine the most appropriate diagnostic and therapeutic approach. Considering the patient’s presentation with swelling and localised pain near the previous laparoscopic port site, along with clinical suspicion of an incisional hernia, the team assessed the potential risks of hernia progression, adhesions, and complications such as bowel obstruction or strangulation.

Further evaluation, including clinical examination and imaging with abdominal ultrasound and contrast-enhanced CT scan, confirmed the diagnosis of a 1 cm incisional hernia with omental adhesions. It was determined that laparoscopic IPOM plus repair was identified as the most effective medical approach to repair the hernia defect, reduce adhesions, and prevent recurrence or serious complications.

The patient and her family were informed about her condition, the procedure, its associated risks, and its potential to alleviate symptoms and enhance her quality of life.

Surgical Procedure

Following the decision, the patient was scheduled to undergo Laparoscopic Intraperitoneal Onlay Mesh (IPOM) Plus Surgery in Hyderabad at PACE Hospitals, under the supervision of an expert in the Surgical Gastroenterology Department.

The following steps were carried out during the procedure:

Patient Preparation and Anesthesia: The patient was admitted, preoperative assessments, including investigations and pre-anesthetic checkup, were completed. After adequate preparation, general anesthesia was administered, and the patient was positioned appropriately for laparoscopic surgery.

Port Placement and Exploration: Laparoscopic ports were inserted, and a thorough exploration of the abdominal cavity was performed. Extensive omental adhesions to the anterior abdominal wall were identified.

Adhesiolysis: Careful adhesiolysis was carried out to free the omentum and other tissues adhered to the anterior abdominal wall, creating a clear surgical field for hernia repair.

Identification and Repair of Hernia Defect: A 1 cm defect was identified over the previous laparoscopic port site in the left upper quadrant (LUQ), with omentum as the hernia content. The defect was closed using 1-prolene sutures.

Mesh Placement and Fixation: A 15 x 15 cm dual mesh was placed over the closed defect to reinforce the abdominal wall. The mesh was securely fixed with tackers to prevent recurrence. The procedure was completed without complications.

Postoperative Care

The procedure was uneventful, and the patient’s postoperative recovery was satisfactory. During her hospital stay, she received intravenous fluids, IV antibiotics, laxatives, and other supportive medications. She showed symptomatic improvement and is being discharged in stable condition with the following advice.

Discharge Medications

Upon discharge, the patient was prescribed an antibiotic to prevent postoperative infections, a proton pump inhibitor to reduce gastric acidity and protect the gastrointestinal tract, and a prokinetic agent to enhance gastrointestinal motility. Additionally, analgesic was provided for pain management, along with a laxative to maintain regular bowel movements and prevent constipation and advised to continue old medication.

Advice on Discharge

The patient is advised to wear an abdominal binder continuously for eight weeks to provide support and aid in healing. She was advised to avoid any activities that involve straining or heavy physical exertion during the recovery period. A soft diet was recommended to minimise abdominal discomfort and facilitate digestion.

Emergency Care

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms such as fever, abdominal pain and vomiting.

Review and Follow-up Notes

The patient was advised to return for a follow-up visit with the Surgical Gastroenterologist in Hyderabad at PACE Hospitals, after 5 days for further evaluation.

Conclusion

This case highlights the successful management of an incisional hernia through a laparoscopic IPOM plus procedure. Careful adhesiolysis and defect repair with mesh placement resulted in uneventful surgery and satisfactory postoperative recovery. Timely intervention and appropriate postoperative care ensured symptom resolution and minimized the risk of complications.

Redefining Abdominal Wall Repair – The Expertise of a Surgical Gastroenterologist in Minimally Invasive Hernia Management

This case exemplifies how the specialised skills of a surgical gastroenterologist / surgical gastroenterology doctor can elevate the standard of care in abdominal wall reconstruction. Faced with a symptomatic incisional hernia complicated by adhesions, the surgical team employed the laparoscopic IPOM plus technique—a sophisticated, minimally invasive approach that demands precision and deep anatomical understanding. The ability to perform meticulous adhesiolysis and defect closure, followed by mesh reinforcement, showcases the advanced capabilities of surgical gastroenterology in ensuring optimal outcomes with reduced patient morbidity. This reinforces the evolving and indispensable role of surgical gastroenterologists in managing complex abdominal pathologies with finesse and innovation.