Postoperative interstitial hernia as a cause of obscure incisional wound site pain

Area of Science:

• Abdominal Wall Surgery
• Hernia Repair
• Minimally Invasive Surgery

Background:

• Interstitial hernias are rare, with the hernia sac located between layers of the abdominal wall.
• Literature review indicates they are most commonly observed in children as inguinal hernias, often associated with undescended testes.
• The typical location is between the external oblique and internal oblique muscles, directed laterally and cranially.

Observation:

• The authors report three cases of interstitial hernia identified during laparoscopic anterior abdominal wall exploration.
• These cases presented as complications following appendectomy and post-radiotherapy wound healing for uterine and cervical cancer.
• None of the patients had a prior diagnosis of hernia, and the exploration was initiated due to incisional wound site pain.

Findings:

• Interstitial hernias can occur as a complication of abdominal surgery and radiotherapy.
• Laparoscopic examination of the anterior abdominal wall is effective in diagnosing these hernias.
• The condition should be considered in patients presenting with unexplained incisional pain.

Implications:

• Considering interstitial hernias in the differential diagnosis of obscure incisional pain is crucial.
• Laparoscopic techniques offer a viable approach for both diagnosis and treatment of anterior abdominal wall hernias.
• This highlights the importance of thorough evaluation in persistent postoperative pain, even without a prior hernia diagnosis.