Case Report of International Journal of Case Reports
Complex Incisional Hernia – Easy To Diagnose But What To Do After?
Mihai Toma1,5, Iuliana Sofian2, Adrian Pavel3, Carmen Elena Bucuri1,6, Dimitris Marin Argyriou4, Valentin Oprea1
1Clinical Department of Surgery – Military Emergency Clinical Hospital “Dr. Constantin Papilian” Cluj-Napoca; 2Clinical Department of Intensive Care Unit – Military Emergency Clinical Hospital “Dr. Constantin Papilian” Cluj-Napoca;3Clinical Department of Radiology – Military Emergency Clinical Hospital “Dr. Constantin Papilian” Cluj-Napoca;4.1st Clinical Department of Obstetrics and Gynecology – County Emergency Clinical Hospital Târgu Mureș; 5“George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology Târgu Mureș; 6“Iuliu Hatieganu” University of Medicine and Pharmacy Cluj-Napoca
Introduction. Loss of domain represents a defect in abdominal wall or loss of continuity of fascial closure, with more than 20% of the peritoneal cavity content under the skin in a serous sac, where the reconstruction involves additional reconstructive techniques. Clinical Case. A 63-year-old active smoker with multiple comorbidities such as COPD severe form with the need for oxygen at home (may be an absolute contraindication) and surgical history of open umbilical hernia repair with a rapid development of loss of domain hernia (2 weeks after surgery) was prepared preoperatively with Botulinum Toxin type A and Preoperative Progressive Pneumoperitoneum. Discussion. Despite comorbidities, by optimizing the abdominal wall with Botulinum Toxin type A and Preoperative Progressive Pneumoperitoneum with the intraoperative use of the Rives-Stoppa technique or posterior separation of components, Abdominal Wall Strength Score improves significantly in a short time, with quick socio-economic reintegration and low-rate of complications. Conclusions. By preoperative preparation, with augmentation techniques of the abdominal wall, thus, even the barriers given by comorbidities (absolute contraindications) are overcame, with low postoperative risks, offering the patient a normal quality of life.
Keywords: Complex incisional hernia; Optimization; Botulinum toxin A; Pneumoperitoneum; Augmentation; Posterior component separation
How to cite this article:
Mihai Toma, Iuliana Sofian, Adrian Pavel, Carmen Elena Bucuri, Dimitris Marin Argyriou, Valentin Oprea. Complex Incisional Hernia – Easy To Diagnose But What To Do After? . International Journal of Case Reports, 2021; 5:254. DOI: 10.28933/ijcr-2021-11-1506
1. Itatsu, K., et al. “Incidence of and risk factors for incisional hernia after abdominal surgery.” Journal of British Surgery 101.11 (2014): 1439-1447.
2. Stabilini, Cesare, et al. “Preventing Incisional Hernias: Closure of Abdominal Wall, Follow-Up in Abdominal Surgery.” Abdominal Wall Surgery. Springer, Cham, 2019. 71-83.
3. Parker, Samuel G., et al. “Definitions for loss of domain: an international delphi consensus of expert surgeons.” World journal of surgery 44.4 (2020): 1070-1078.
4. Ibarra-Hurtado, T. R., et al. “Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management.” Hernia 18.5 (2014): 647-652.
5. Weissler, Jason M., et al. “Chemical component separation: a systematic review and meta-analysis of botulinum toxin for management of ventral hernia.” Journal of plastic surgery and hand surgery 51.5 (2017): 366-374.
6. Alam, Nasra N., et al. “Methods of abdominal wall expansion for repair of incisional herniae: a systematic review.” Hernia 20.2 (2016): 191-199.
7. Mayagoitia, J. C., et al. “Preoperative progressive pneumoperitoneum in patients with abdominal-wall hernias.” Hernia 10.3 (2006): 213-217.
8. Martínez-Hoed, J., S. Bonafe-Diana, and J. Bueno-Lledó. “A systematic review of the use of progressive preoperative pneumoperitoneum since its inception.” Hernia (2020): 1-16.
9. Novitsky, Yuri W. “Posterior component separation via transversus abdominis muscle release: the TAR procedure.” Hernia surgery. Springer, Cham, 2016. 117-135.
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