Spontaneous abdominal intercostal hernia after laparoscopic vertical gastrectomy. Review of literature

Abstract

Introduction: Spontaneous abdominal intercostal hernia (AIH) is exceptional. Different risk factors related to the onset of this hernia have been described. The treatment is surgical, although there is controversy over the most appropriate technique and approach. Objective: Report a case of AIH after a laparoscopic vertical gastrectomy unrelated to surgical incisions. Review the AIH described in the literature. Methods: A total of 35 cases have been reviewed, analyzing pathogenic mechanism, age, sex, size of hernia defect, laterality, affected intercostal space, clinical, treatment and evolution. Results: 40 % of AIH are traumatic, 37.1 % spontaneous and 22.8 % post-surgical (incisional hernias). Mean age is 58.4 years and have been more common in males (81.4 %) and located on the left side between 8th and 10th intercostal spaces. Main predisposing factors related to spontaneous AIH are obesity, smoking and chronic obstructive pulmonary disease. The most commonly used surgical treatment has been open repair on the tumor itself with the placement of prosthetic material. Six laparoscopic and three robotic repairs have been described, but there are not long-term results. Recurrence rate has been 22.7 %, in all the cases after meshless repairs. Conclusions: First spontaneous AIH after bariatric laparoscopic surgery is reported. Obesity, coughing from active smoking and fast weight loss after bariatric surgery are possible predisposing factors in our case. Minimally invasive surgery (laparoscopic or robotic) offers well-known advantages but there are few cases reported with short-term follow-up, to conclude that it is the treatment of choice.