Emergency laparoscopic "hybrid" intraperitoneal on-lay mesh (IPOM +) repair of incarcerated umbilical hernia in patient with BMI 62 and small bowel obstruction; a case based review.

Abstract

<h4>Introduction</h4>Large abdominal incisions in patients with obesity carry high rates of systemic and wound complications. European Hernia Society guidelines recommend laparoscopic intraperitoneal on-lay mesh (IPOM) repair for large hernia defects and those at higher risk of wound morbidity, ideally with defect closure and 5 cm mesh overlap. We describe IPOM repair in a patient with BMI 62 and relate this to current evidence in obesity.<h4>Case presentation</h4>A 69-year-old morbidly obese woman (BMI 62) with multiple comorbidities presented as an emergency with 5 days of vomiting and abdominal pain. CT confirmed small bowel obstruction due to a ventral abdominal wall hernia. Operative findings revealed an obstructed paraumbilical hernia containing small bowel and omentum. A laparoscopic "hybrid" IPOM + repair was performed with generous mesh overlap. Recovery was uneventful with no surgical complications.<h4>Discussion</h4>Minimally invasive approaches are preferred in obesity, with evidence suggesting lower perioperative complications and recurrence than open repair. Challenges include surgeon expertise, timing, ergonomics, distorted surface landmarks, need for higher pneumoperitoneum pressures, and their physiological effects.<h4>Conclusion</h4>With careful planning, IPOM ventral hernia repair is a viable option for obese patients, even in emergencies. Defect closure is recommended whenever feasible. A hybrid approach-limited incision and sac excision after laparoscopic closure-may reduce postoperative seroma risk.