Clinical & Medical Case Reports

Background: A wound protector has been recommended for hernia repairs to improve surgical exposure and to reduce the rate of surgical site infections (SSI). However, in patients needing laparoscopy, wound protectors create barriers for achieving complete seal of the abdominal cavity.

 

Case Study: A 53-year-old man presented with a two-year history of right upper quadrant pain and bloating. He was diagnosed with biliary colic and progressed to a laparoscopic cholecystectomy and open suture repair of an incidental umbilical hernia. His symptoms did not resolve and his umbilical hernia reoccurred within 12 months. He was therefore booked for another laparoscopy (diagnostic) and repairs of umbilical hernia with mesh. In order to achieve this, an Alexis was used. Subsequently, a GelPortTM was placed over the Alexis who achieved a good seal for the laparoscopy, facilitating the identifi cation of adhesion. This was successfully divided and his umbilical hernia was fixed with mesh. His pain was subsequently resolved and to date there was no recurrence of his umbilical hernia.

 

Discussion: Umbilical/ventral hernia is common surgical presentations. With increasing prevalence of obesity, fixation of these types of hernias can be technically challenging. A wound protector such as AlexisTM has been previously demonstrated to be beneficial by increasing exposure and decreasing risk of SSI. However, it could be challenging if patients necessitate fixation of umbilical hernia and laparoscopy simultaneously. Utilizing the GelPortTM system could facilitate completing both procedures successfully concurrently, and thus, reducing the cost associated with another surgery or complications such as recurrence and infection.