Thermal injury to the linea alba during laparoscopic ventral transabdominal pre-peritoneal repair leading to large incisional hernia: A case report

Laparoscopic ventral transabdominal pre-peritoneal (vTAPP) repair is gaining popularity as a promising technique for ventral hernia repair. However, data on complications specific to this approach are limited. We report the case of a 35-year-old gentleman who underwent laparoscopic vTAPP repair for a 2 cm epigastric hernia at another hospital. The patient developed a progressive incisional hernia 6 months later, with imaging revealing a 13 cm × 10 cm midline defect. Re-exploration revealed necrosis of the linea alba, likely secondary to thermal injury during the initial surgery. Anterior component separation with placement of a large polypropylene mesh was performed, and the patient recovered well, with no recurrence at 12-month follow-up. This case emphasises the potential for thermal injury during laparoscopic vTAPP, resulting in fascial necrosis and formation of a large hernia. Careful dissection techniques and limited use of energy devices in the midline are critical to avoid this rare complication.