Internal Hernia Through the Pars Flaccida: A Rare Intraoperative Finding

BACKGROUND Internal hernias through the pars flaccida of the lesser omentum are rare variants that pose unique diagnostic and therapeutic challenges, representing less than 1% of all internal hernias. Diagnosis is particularly challenging due to their nonspecific presentation and subtle radiological features. CASE REPORT We present a case of successful laparoscopic repair of a pars flaccida internal hernia in a 52-year-old woman with complex surgical history, including previous colorectal cancer surgery. We detail our systematic surgical approach and conducted a comprehensive literature review of laparoscopically managed pars flaccida hernias using the PubMed database. The patient presented with recurrent episodes of epigastric pain and nausea. Diagnostic laparoscopy revealed herniation of the small bowel through the pars flaccida anterior to the stomach, along with a secondary mesenteric defect. Both defects were successfully repaired laparoscopically using non-absorbable sutures. Key technical elements included strategic 5-port placement, systematic adhesiolysis, and meticulous reduction of the herniated bowel. The patient's symptoms resolved after repair. CONCLUSIONS Laparoscopic repair of pars flaccida hernias is feasible with appropriate technical expertise. Success depends on careful preoperative planning, strategic port placement, and thorough inspection for additional defects. This case highlights the importance of considering internal hernias in patients with intermittent abdominal pain following previous surgery, even when initial imaging is inconclusive.