Hybrid laparoscopic/open mesh repair of combined bilateral arcuate line and ventral hernias

Arcuate line hernia (ALH) is a rare entity with only few cases reported in the literature. ALH is difficult to diagnose clinically and is most of the time asymptomatic, and there is no real consensus on how to better surgically approach this condition. We hereby present the case of a female patient with a symptomatic partly reducible ventral hernia. At laparoscopy, bilateral ALHs were incidentally identified and simultaneously treated, using a safe hybrid technique. The postoperative outcome was uneventful and she is still symptom-free with no clinical evidence of hernia recurrence at 2-year postsurgery. ALH is an uncommon interstitial parietal hernia and its diagnosis is often incidentally made peri-operatively, thus reinforcing the benefit of laparoscopy. In a most complex situation of combined bilateral ALHs with ventral hernia, a hybrid laparoscopic/anterior approach is a safe alternative and we recommend mesh reinforcement of all defects.