1. General Surgery Case Presentation Sundeep Guliani

2. 62 yo female with unobstructing symptomatic right flank hernia PSH: Hysterectomy, vaginal prolapse repair both via pfannenstiel incisions

4. Cont OR – Lap Assisted –Swiss cheese pelvic hernias –Incarceration reduce laparoscopically –Right flank open primary hernia repair –Laparoscopic placement of mesh POD 4 –N,V,Abd distention -> CT scan

6. Re-exploration Via lower midline incision, primary repair hernia defect DC POD 5

7. 27 pts with average 188 cm hernia defect evaluated Found repair was technically feasible but often required very large mesh Follow up short but no operative complications

8. Teaching points/Issues Small defect vs large These type of hernias are technically challenging