Acute Surgical Repair of Large Incisional Hernia with Significant Loss of Domain: Case Report and Review of Literature

Abstract

Introduction: Incisional abdominal hernias develop up to 11.5 % of laparotomy incisions. The most difficult to repair are hernias with significant loss of domain. The basic principle of treating abdominal incisional hernia entails restoring the anatomical and physiological integrity of the wall. Ideally, thisinvolves the use of local musculo-aponeurotic tissue with a good blood supply and innervations. In the case of large defects, it is necessary to use alloplastic materials in order to reduce the tension load on the suture itself. Emergency surgery is indicated especially in the case of intestinal obstruction or strangulation. Presentation of Case: The present report describes the case of emergency surgical treatment of intestinal obstruction in large abdominal incisional hernia by 77-year old man. We used reposition and onlay technique with with biodegradable mesh to repair the abdominal wall. Discussion: Emergency surgery for bowel obstruction primarily aims to resolve bowel obstruction and restore intestinal viability. In this case we present that techniques without bowel resection or stoma are safer as the other. Large hernias with loss of domain can be repaired only by an open method and the onlay method is the simplest and most versatile technique in this case. Conlusions: Emergency surgery in incisional hearnias is a challenging surgical problem due to risk of the preoperative and postoperative complications. Team involving general and plastic surgeons and anaesthetist is required.