P-074 SAILING ROUGH SEAS – MANAGING THE COMPLEX RECURRENT INCISIONAL HERNIA PATIENT WITH ADJUVANT TECHNIQUES – CASE REPORT

Abstract

Abstract Aim Case report regarding the repair of a complex incisional hernia, with loss of domain (LoD), where adjuvant techniques were used. Materials and methods Data from the patient's electronic chart and literature review. Results A 77-year-old female patient is referred for evaluation. She had a multi-recurrent incisional hernia, symptomatic with pain and recurrent episodes of intestinal occlusion. Clinical and imaging evaluation confirmed a complex incisional hernia with LoD, located in the left iliac and flank regions. Abdominal wall muscle blockade was done with botulinum toxin. A progressive pneumoperitoneum catheter was placed laparoscopically, and 11 liters of air were instilled over 13 days. Imaging showed lengthening of the AW muscles. Posterior component separation and transversus abdominis release was performed on the left side, and a retrorectus dissection the right side. A macroporous polypropylene mesh was attached on the left to the twelfth rib, psoas muscle, transverse process of lumbar vertebrae, iliac crest, Cooper's ligament and pubis, and on the right with transfascial sutures. A seroma developed on the post operative period. No other complications occurred. Discussion If a patient never had an AW reconstruction surgery, with a mesh on the retromuscular plane, this option should be offered, by a specialized hernia surgeon, regardless of the number of recurrences. Progressive pneumoperitoneum has existed for many years, but is seldom used. Likewise, botulinum toxin is emerging as a powerful tool to prepare AW reconstruction, but much is still unknow. Heterogeneity in the data is a hinderance to the wide adoption of these techniques.