Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 26, 2020; 8(2): 362-369
Published online Jan 26, 2020. doi: 10.12998/wjcc.v8.i2.362
Mesh repair of sacrococcygeal hernia via a combined laparoscopic and sacrococcygeal approach: A case report
Yuan-Qiang Dong, Li-Jia Liu, Zan Fu, Si-Meng Chen
Yuan-Qiang Dong, Li-Jia Liu, Zan Fu, Si-Meng Chen, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, Jiangsu Province, China
Author contributions: Chen SM designed the study and planned the managements; Chen SM, Fu Z, and Dong YQ were the patient's surgeons and provided all treatments, including the surgical operation; Dong YQ and Chen SM reviewed the literature and contributed to manuscript writing; Liu LJ contributed to revision of the manuscript; all authors issued final approval for the version to be submitted.
Informed consent statement: Written informed consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Si-Meng Chen, MD, Chief Doctor, Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, No. 300, Guangzhou Road, Nanjing 210029, Jiangsu Province, China. chensimengnj@163.com
Received: November 9, 2019
Peer-review started: November 9, 2019
First decision: November 19, 2019
Revised: November 30, 2019
Accepted: December 14, 2019
Article in press: December 14, 2019
Published online: January 26, 2020
Processing time: 68 Days and 15.8 Hours
Abstract
BACKGROUND

Sacrococcygeal hernia is a very rare condition that is usually secondary to sacrococcygectomy, and its ideal treatment regimen is unclear. Herein, we report a case of sacrococcygeal hernia occurring in a patient who had no history of sacrococcygeal operation, present the operative procedures of mesh repair via a combined laparoscopic and sacrococcygeal approach that has not been described, and discuss our experience in diagnosis and treatment with a review of the literature.

CASE SUMMARY

A 54-year-old woman who chiefly complained of a 10-year history of a reversible bulge in her right sacrococcygeal region was admitted to our hospital. The physical examination revealed a bulge in the right sacrococcygeal region upon standing, which disappeared in the prone position but relapsed when performing the Valsalva manoeuvre. Computed tomography displayed an abnormality in the structure of the tissues between the midline of the sacrococcygeal region and the right gluteus muscle. The patient was diagnosed with sacrococcygeal hernia and received hernia repair with mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally, and a defect was identified in the right anterior sacrococcygeal region through which part of the rectum protruded. This was followed by the placement of a self-gripping polyester mesh via a sacrococcygeal approach. There were no postoperative complications. The patient was discharged on postoperative day 7 and was followed for more than 6 mo with no recurrence.

CONCLUSION

Laparoscopic mesh repair is recommended as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.

Keywords: Sacrococcygeal region; Hernia; Mesh repair; Surgical approach; Laparoscopy; Case report

Core tip: A 54-year-old woman was diagnosed with a sacrococcygeal hernia. The patient received hernia repair with a mesh through a combined laparoscopic and sacrococcygeal approach. On laparoscopy, the rectum was dissected posterolaterally to return the hernia content and to expose the defect in the right anterior sacrococcygeal region. This was followed by the placement of a self-gripping polyester mesh via a sacrococcygeal approach. There were no postoperative complications, and the patient was followed for more than 6 mo with no recurrence. Our experience demonstrates that laparoscopic mesh repair can serve as a priority of surgical options for sacrococcygeal hernias, while choosing a self-gripping mesh can help avoid the risk of presacral vessel injury by reducing suture fixation.