Endoscopic Mini- or Less-Open Sublay Repair in a Patient with a Reduced Pulmonary Function: A Case Report

Endoscopic mini- or less-open sublay (EMILOS) is a minimally invasive extraperitoneal repair technique through a small incision that allows wide mesh placement, which may reduce surgical site infection, postoperative pain, and respiratory compromise. In the present case, we performed umbilical hernia repair using EMILOS in an elderly patient with an impaired pulmonary function, and the procedure was performed safely without major postoperative respiratory complications.

An 86-year-old female with asthma using inhaled budesonide-formoterol and mixed ventilatory impairment presented with abdominal pain and a firm umbilical bulge. CT revealed a 38 × 36-mm umbilical hernia with an acutely irreducible small bowel. Elective repair was planned after manual reduction. Given low pulmonary reserve and anticipated airway hyperreactivity, we selected general anesthesia with a supraglottic airway device (SGA) and an EMILOS repair. Through a 3-cm skin incision caudal to the umbilical bulge, the hernia sac was dissected. The retrorectus space was developed, and a 16 × 15-cm monofilament mesh was deployed and secured. Finally, the linea alba and anterior rectus sheath were closed.The postoperative course was generally uneventful. Discharge was delayed for social reasons, and the patient was discharged on day 14. At the 6-month follow-up, there was no evidence of any infection or recurrence.

This case suggests that EMILOS may allow curative treatment with relatively low invasiveness in carefully selected elderly patients with impaired pulmonary function. The use of an SGA may be a reasonable option for respiratory management in this context. However, the indication for surgery should be individualized, and conclusions regarding its benefit should be interpreted with caution due to the single-case nature of this report.