Abstract
An 85-year-old woman visited our hospital complaining of a right subcostal swelling one-and-a-half years after undergoing open surgery for acute cholecystitis. Plain abdominal computed tomography showed a large abdominal wall defect measuring 15.0 ×13.5 cm just below the previous subcostal incision. The patient was diagnosed with a subcostal incisional hernia (SCIH) and underwent laparoscopic repair using the Intraperitoneal Onlay Mesh-Plus (IPOM-Plus) method. Laparoscopic adhesiolysis was performed around the hernial orifice, and the abdominal wall defect was sutured through an anterior approach. A mesh was fixed laparoscopically using tacking and transfascial sutures. Close attention was required to fix the mesh in the narrow space between the costal margin and the hernia defect, and no fixation was performed above the costal margin. Reportedly, surgical repair of SCIH, which is a relatively rare condition, is challenging, and this is the first report describing this surgery in Japan. In our view, our strategy using IPOM-Plus for SCIH repair is safe and effective.
