Dual Application of Mesh through Hybrid Technique in Large Incisional Hernia: A Case Report

Although single mesh insertion is recommended for simple incisional hernia, there is no established treatment of choice for severe incisional hernia accompanied with large muscular defects. Single mesh insertion cannot provide sufficient mechanical force, and muscle flaps could lead to donor site morbidity while also requiring longer operation times. In this case, dual application of mesh through a hybrid technique could be a good option. A 46-year-old woman with rectus abdominis muscle defect due to previous surgery visited our clinic with abdominal bulging. Abdomen-pelvis computed tomography demonstrated a 6.5×11.5 cm rectus abdominis defect along with small bowel herniation. We decided to reinforce the existing hybrid intraperitoneal onlay mesh technique through additional insertion of suprafascial mesh to prevent recurrence and minimize complications. The patient’s abdominal contour was well preserved postoperatively for 1 year. We believe dual-layer mesh insertion through a hybrid approach could be a better alternative for severe incisional hernia with large muscle defects because of its treatment efficacy, short operation time, simple technical requirements, and absence of donor or flap complications.