Laparoscopic pelvic surgery after reconstructive surgery with vertical rectus abdominis muscle flap: A case report

Kimihiro Nishino; Yoshiki Ikeda; Kazuhisa Kitami; Kaoru Niimi; Hiroaki Kajiyama

doi:10.1016/j.ijscr.2021.106706

Laparoscopic pelvic surgery after reconstructive surgery with vertical rectus abdominis muscle flap: A case report

Int J Surg Case Rep. 2022 Jan:90:106706. doi: 10.1016/j.ijscr.2021.106706. Epub 2021 Dec 20.

Authors

Kimihiro Nishino¹, Yoshiki Ikeda², Kazuhisa Kitami², Kaoru Niimi², Hiroaki Kajiyama²

Affiliations

¹ Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan. Electronic address: kimikimi@med.nagoya-u.ac.jp.
² Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.

Abstract

Introduction: Patients who have experienced vertical rectus abdominis muscle (VRAM) flap reconstruction are under risk of the abdominal incisional hernia (donor site hernia), and laparotomy increases the risk.

Presentation of the case: We present the case of a 71-year-old nulliparous woman who experienced radical vulvectomy against extramammary Paget disease and reconstructive surgery with VRAM flap 7 years ago and developed right ovarian tumor. In this case, right ovarian tumor was removed with laparoscopic surgery, instead of laparotomy, and the risk of incisional hernia was successfully minimized.

Discussion: Incisional (donor site) hernia after reconstructive surgery using VRAM flap has been reported in between 2 and 10%. While VRAM flap can fill larger amount of skin and subcutaneous tissue to recipient site, the risk of postoperative incisional hernia of abdominal wall is substantial.

Conclusion: Reconstructive surgery of with VRAM flap is required for extramammary vulvar Paget disease expanding wide range, and develops the risk of incisional hernia. Laparoscopic surgery should be applied in patients who have experienced VRAM flap reconstruction and developed pelvic tumor for avoiding the risk of incisional hernia as long as it can be allowed on oncologic aspects such as recurrence.

Keywords: Case report; Incisional hernia; Ovarian tumor; Vertical rectus abdominis myocutaneous (VRAM) flap.