Laparoscopic preperitoneal repair for primary falciform ligament herniation

• Published in: Annals of the Royal College of Surgeons of England Vol. 102; no. 5; pp. e102 - e104
• Main Authors: Liang, T J, Wang, K C, Tsai, C C, Chen, I S
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-05-2020; Royal College of Surgeons
• Subjects: Abdomen; Abdominal surgery; Abdominal Wall - diagnostic imaging; Abdominal Wall - pathology; Abdominal Wall - surgery; Aged; Female; Hernia, Abdominal - diagnosis; Hernia, Abdominal - pathology; Hernia, Abdominal - surgery; Hernias; Humans; Laparoscopy; Ligaments; Ligaments - diagnostic imaging; Ligaments - pathology; Online Case Report; Pathogenesis; Patients; Sutures; Treatment Outcome; Ultrasonic imaging; Ultrasonography; Taiwan; Epigastric hernia; Laparoscopy; Falciform ligament; Ventral hernia
• ISSN: 0035-8843; 1478-7083
• DOI: 10.1308/RCSANN.2020.0032

Epigastric hernia involving the falciform ligament is exceptionally rare. Most reported cases are incisional hernia secondary to prior abdominal surgery. We report a case of primary falciform ligament herniation into the epigastric region repaired by the laparoscopic preperitoneal approach. In this case, an accompanying vessel along the herniated falciform ligament was identified. This finding provides a basis for the hypothesis of a perforating vessel piercing the linea alba and thereby creating a weak point for hernia protrusion (Moschowitz theory). The patient had an uneventful recovery and was discharged home on the postoperative day two. A laparoscopic preperitoneal approach is feasible for the repair of primary falciform ligament herniation. The magnified endoscopic view enables surgeons to achieve definite repair without missing occult defects.