A Case of Laparoscopic Subxyphoid Hernia Repair after Pedicled Omental Grafting for Mediastinitis

Abstract

A 77-year-old woman presented to our hospital because of precordial distention after the meal. There was a previous history of undergoing pedicled omental grafting for mediastinitis following coronary artery bypass operation. She had been aware of precordial distention from the postoperative period, but recently precordial distention and pressure sensation after the meal were aggravated. She thus presented to our hospital. Thoracoabdominal CT scan revealed that the greater omentum and the stomach had prolapsed from the subxiphoid to presternal area. Subxyphoid hernia after pedicled omental grafting for mediastinitis after open heart surgery was diagnosed, and hernia repair was performed under laparotomy. At surgery, the grafted omentum was preserved and keyhole was created in a mesh, with which the hernia orifice was covered. The hernia recurred about 2 months after the operation. Laparoscopic reoperation was performed, when we confirmed that the keyhole created at the former operation had become the hernia orifice. We transected the omentum, covered the entire hernia orifice with a mesh and completed the repair. Thereafter no findings suggestive of recurrence and omental necrosis have been encountered. Although incisional hernia is known as a complication after omental grafting for mediastinitis, few cases performed laparoscopic hernia repair have been reported. We present our case with a review of the literature.