Laparoscopic posterior component separation (transabdominal retromuscular + transversus abdominis release) for obstructed incisional hernia with ventriculoperitoneal shunt entrapment

Ventriculoperitoneal (VP) shunt placement is the most common treatment for hydrocephalus. Abdominal complications occur in up to a third of the patients, but incisional hernia at the site of catheter entry and presenting as acute intestinal obstruction is a rare occurrence. A 47-year-old female presented with an acute abdomen and on examination was found to have an irreducible L2W1 incisional hernia. Radiology revealed herniation of a loop of small bowel along with the intraperitoneal part of the VP shunt. Emergency diagnostic laparoscopy confirmed the findings. The bowel loop was reduced; the VP shunt was repositioned using a percutaneous suture passer. Hernia was repaired by performing a laparoscopic transabdominal retromuscular mesh repair with right transversus abdominis release. A minimally invasive approach, along with posterior component separation, allowed for a durable hernia repair, eliminated mesh-shunt contact, minimised complications and enhanced recovery.