An Adapted Hybrid of Open and Laparoscopic Techniques for Ventral Hernia Repair in a Resource-Constrained Setting.

Abstract

Ventral hernias are common surgical conditions managed through various techniques, including open, laparoscopic, and hybrid approaches. Laparoscopic repairs offer advantages such as reduced postoperative pain and faster recovery but carry an increased risk of bowel injury. Of all the repairs, retrorectus repair has demonstrated superior long-term outcomes. In resource-limited settings, adapting existing techniques, with consideration of cost, is essential to enhance patient safety and surgical efficiency. This report presents the case of a 65-year-old female, known hypertensive with a BMI of 33, presenting to a regional hospital in South Africa, with a symptomatic ventral hernia measuring 51 mm × 36 mm. The hernia contained portions of the transverse colon and omentum. Due to the symptomatic nature and risk of complications, surgical intervention was indicated. A hybrid technique combining open and laparoscopic methods was employed, accessing the retrorectus plane via a small incision, followed by gel port placement to facilitate laparoscopic dissection and mesh placement. The patient had an uneventful recovery, was discharged on postoperative day two, and experienced no complications on follow-ups. This case highlights a cost-effective, minimally invasive adaptation of retrorectus repair suitable for resource-constrained settings. The technique minimizes surgical trauma and enhances cosmetic outcomes while maintaining the benefits of minimally invasive surgery. Further studies are needed to evaluate long-term outcomes and broader applicability.