Laparoscopic paraduodenal hernia repair with bioabsorbable mesh: A case of a novel technique for a rare cause of bowel obstruction.

Kwan, Bianca; Theodore, Jane E; Wong, Jason

INTRODUCTION Paraduodenal hernias are the most common type of internal hernia but a rare cause of bowel obstruction. Given the high risk of incarceration, obstruction and associated mortality, surgical repair is recommended. PRESENTATION OF CASE We present a novel technique for laparoscopic repair of paraduodenal hernia using biosynthetic mesh to reinforce suture closure of the hernia defect. An 18-year-old healthy female presented with symptoms of recurrent subacute small bowel obstruction and right paraduodenal hernia was diagnosed on computed tomography (CT). Laparoscopic repair was performed with reinforcement of suture repair with GORE® BIO-A® Hiatal Tissue Reinforcement to decrease the risk of recurrence. The patient had an uneventful recovery and was discharged on the second post-operative day. Subsequent follow-up revealed complete resolution of symptoms. DISCUSSION Biosynthetic tissue reinforcement carries a lower theoretical risk of erosion than permanent mesh. A hiatal-shaped prosthesis represents a suitable shape for paraduodenal hernia repair. CONCLUSION We present the first reported use of bioabsorbable mesh to repair paraduodenal hernia. This technique may minimise risk of mesh erosion and can be considered a safe and effective approach where suture repair is inadequate due to large defect size.