Abstract
A 45-year-old woman had developed strangulated bowel obstruction after a Cesarean section 12 years earlier ; this had been treated by small intestinal resection and colostomy, and the stoma was later closed. Eight years earlier, she had undergone hernia repair (simple closure) for an abdominal incisional hernia at the stoma closure site, and five years earlier, the abdominal incisional hernia recurred. She presented to our department with recent pain. Computed tomography showed hernia orifices with diameters of 15 mm and 30 mm in the right flank. The patient had been diagnosed with dermatomyositis 18 years previously and was taking oral prednisolone 10 mg, and consequent tissue fragility and central obesity meant that there was a high risk of further recurrence if simple closure was again performed. Since the patient was also an immunocompromised host, the use of mesh may have been problematic in light of the high difficulty of treating a surgical site infection. It was therefore decided to close the hernia orifice by turning over the anterior rectus abdominis sheath and repair the hernia with an autologous fascia lata graft. In the presence of tissue fragility, patients with recurrent abdominal incisional hernia are at high risk of further recurrence. Choosing a suitable surgical procedure taking into account patient attributes may reduce the rate of recurrence.
