Laparoscopic repair for recurrent abdominal wall hernia after TRAM flap breast reconstruction: case report of 2 patients.
BACKGROUND
The transverse rectus abdominis musculocutaneous (TRAM) flap is an appealing option for women choosing between various breast reconstructive techniques as it results in an autologous reconstructed breast that is soft and mimics a natural breast. Despite these benefits, there are complications with this procedure, such as pain at the donor site, longer scars, and most frequently the occurrence of abdominal wall hernia or bulge, which has been reported in up to 20%-40% of patients.


METHODS
In this case report, we share our experience with 2 patients who had multiple open hernia repairs, 5 between the 2 of them, after their TRAM flap surgery. Each of these 5 repairs was performed with a Prolene mesh overlay, but not one lasted for more than 6 months. After reviewing our patients' records and our surgical options, we decided to proceed with laparoscopic repair of their recurrent hernias.


RESULTS
The patients are now at postoperative follow-up of 12 months and 15 months, with no evidence of recurrence.


CONCLUSIONS
Laparoscopic surgery has many benefits, such as shorter hospitalization and decreased pain. For our patients, it also resulted in a more beneficial and longer-lasting repair. We believe that this is partly due to the mechanics of the repair, which allows the abdominal contents to buttress the mesh against the abdominal wall. In addition, we believe that this technique reinforces the posterior sheath, which may not be accomplished in an open repair. This is important as most hernias after TRAM flap surgery occur below the arcuate line. From our experience with these 2 patients, we now advocate the use of laparoscopic repair as a treatment option for those who present with recurrent abdominal wall hernia or bulge after their TRAM flap surgery and believe with more experience it will become a first-line treatment.
Stanford University School of Medicine, Stanford, CA 94306, USA. rbshaw@stanford.edu
Robert B
RB
Shaw
Myriam J
MJ
Curet
David M
DM
Kahn
D034861:Abdominal Wall / Q000601:surgery*; D001943:Breast Neoplasms / Q000601:surgery; D005260:Female; D046449:Hernia, Abdominal / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D016462:Mammaplasty; D008875:Middle Aged; D011183:Postoperative Complications; D017568:Rectus Abdominis / Q000637:transplantation*; D013524:Surgical Flaps; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous