Anterolateral Thigh Flap Repair of Ruptured Incisional Hernia with Intractable Ascites after Laparoscopic Liver...

Area of Science:

• Hepatobiliary surgery
• Abdominal wall reconstruction
• Plastic surgery

Background:

• Incisional hernias are a known complication following abdominal surgery, including laparoscopic liver resection.
• Massive, intractable ascites, particularly in patients with severe cirrhosis, can increase intra-abdominal pressure, leading to complications.
• Ruptured incisional hernias pose a significant risk of infection and peritonitis, especially when ascites is present.

Observation:

• A 78-year-old male with hepatocellular carcinoma developed massive, intractable ascites post-laparoscopic liver resection.
• The ascites caused significant pressure, leading to a ruptured incisional hernia at the umbilical port scar with intestinal prolapse.
• Traditional hernia repair with artificial prosthesis was deemed high-risk due to the infected ascites.

Findings:

• A novel approach involved incisional hernia repair using an anterolateral thigh (ALT) flap, performed in collaboration with plastic surgeons.
• The procedure involved careful dissection to manage adhesions, peritoneal closure, and flap elevation via an inguinal subcutaneous tunnel.
• The patient experienced significant improvement in hernia symptoms and was discharged without complications; ascites resolved with medical management.

Implications:

• This case highlights the successful use of an ALT flap for complex incisional hernia repair in the presence of massive ascites, offering an alternative to prosthetic materials.
• The technique provides a viable reconstructive option for patients with compromised abdominal walls and significant fluid accumulation post-liver resection.
• Successful management underscores the importance of multidisciplinary collaboration in addressing challenging surgical complications.