The use of the Mitek anchoring system on the iliac crest for flank incisional hernia repair
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CASE REPORT
The use of the Mitek anchoring system on the iliac crest for flank incisional hernia repair Raphael Sun & Kent Choi & Bradley Coots
Received: 19 September 2012 / Accepted: 26 November 2012 / Published online: 13 December 2012 # Springer-Verlag Berlin Heidelberg 2012
Abstract Large incisional or ventral hernia repairs continue to be a challenge for general and plastic surgeons. Hernias without tangential fascial substance eventually face problems with recurrence. We present a case report of a patient who had undergone multiple repairs for a right flank incisional hernia which eventually recurred. We demonstrated the successful use of the Mitek® anchoring system in this repair. Using the Mitek® system in hernia repair is an innovative approach for large abdominal hernias with limited areas for fixation of synthetic mesh. Level of Evidence: Level V, therapeutic study Keywords Mitek . Anchoring system . Incisional hernia . Hernia repair . Strattice
Introduction Large incisional or ventral hernia repairs continue to be a challenge for general and plastic surgeons. Hernias without tangential fascial substance eventually face problems with recurrence and the need for reoperation. We present a case report of a patient who had undergone multiple repairs for a right flank incisional hernia. For this repair, we demonstrated the use of the Mitek system to anchor Strattice® (Lifecell Corporation, One Millennium Way Branchburg, NJ, 08876, USA) abdominal mesh to the iliac crest for definitive repair. The repair was successful by alleviating the significant pain and maintaining the body contour. Using the Mitek® (DePuy Mitek, Inc., 325 Paramount Drive Raynham, MA, R. Sun (*) : K. Choi : B. Coots Division of Acute Care Surgery, Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City, IA, USA e-mail: [email protected]
02767, USA) system in hernia repair is an innovative approach when there is a need to anchor onto periosteum.
Case report A 49-year-old male suffered a stab wound to the right flank approximately one decade ago during an altercation. At the time, he underwent abdominal exploration via a large right flank incision for repair of a liver injury. Subsequently, he developed a right flank incisional hernia. He initially presented in 2003 with a lumbar hernia. He underwent an open primary repair with 0 Prolene sutures via exploration from the same lumbar incision. This repair lasted approximately 1 year before his hernia recurred. He was symptomatic with progressively worsening pain. He elected to proceed with an incisional hernia repair in hopes to eliminate his pain. This second repair consisted of a midline laparotomy approach in January of 2011. Omental adhesions were taken down in the right upper quadrant between the liver and anterior abdominal wall. The hernia sacs were mobilized from the defect in the right posterior flank. The right colon was also mobilized. Once the hernia defect was cleared of adhesions, it was closed with interru
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