# Laparoscopic Repair of Transmesosigmoid Hernia Following Robot-Assisted Abdominoperineal Resection: A Case Report

## TL;DR

A rare case of transmesosigmoid hernia following robot-assisted surgery was successfully treated with laparoscopic repair.

## Contribution

This case report highlights the importance of closing mesenteric defects during surgery to prevent internal hernias.

## Key findings

- A transmesosigmoid hernia was diagnosed and repaired laparoscopically after robot-assisted surgery.
- A mesenteric defect created during surgery was identified as the likely cause of the hernia.
- Prompt closure of mesenteric defects is recommended to prevent future hernias.

## Abstract

Sigmoid mesocolon hernia is a rare type of internal hernia that can rapidly progress to vascular compromise, necrosis, and intestinal perforation. Therefore, rapid diagnosis and surgical treatment are important. We present a case of transmesosigmoid hernia following robot-assisted abdominoperineal resection that was successfully treated using a laparoscopic approach.

An 80-year-old woman underwent robot-assisted abdominoperineal resection for anal canal cancer. The postoperative course was uneventful. Two months after the surgery, the patient presented with upper abdominal pain. Computed tomography revealed small bowel obstruction. We diagnosed the patient with strangulating intestinal obstruction and performed emergency laparoscopic surgery. Intraoperative findings revealed small intestinal strangulation and herniation through a defect in the sigmoid mesocolon. The strangulated intestine was released, and the defect was closed using barbed sutures. The patient was discharged on postoperative day 9 without complications. Intraoperative video from the previous surgery showed a small defect in the sigmoid mesocolon suspected to be the origin of the transmesosigmoid hernia. The defect may have formed during the medial approach using an electric scalpel.

We emphasized the need for intraoperative vigilance when using energy devices during mesenteric dissection and any mesenteric defect created during surgical procedures should be promptly closed to prevent subsequent transmesenteric internal hernias.