V-044 ABDOMINAL WALL RECONSTRUCTION OF A POST-HEMIPELVECTOMY INCISIONAL HERNIA: AT THE LIMITS OF WHAT IS POSSIBLE

Abstract

Abstract Incisional hernias in patients with bone defects are a real challenge. There is very little evidence of how to repairing them. Clinical Case 56-year-old patient. He underwent a left external hemipelvectomy for osteosarcoma of the iliac bone in 2012 and a left nephrectomy in 2013. The patient presents an inguinal and right thigh root bulge of progressive growth with severe pain and limited mobility. In the past month, he was unable to walk. Physical examination: inguinal defect, defect in the right thigh root and a large lateral bulge. Preoperative CT scan: atrophy of the left abdominal musculature, absence of the left hemipelvis, left hip prosthesis with a pseudocapsule, a large lumbar defect, and a large defect in the inguinal area. Surgery Dissection of hernia sacs and retroperitoneal/preperitoneal dissection was performed, cranially to the retrodiaphragmatic area, medially to the linea alba, posteriorly to the spine and caudally to the pelvis. The abdominal wall is reconstructed with a polyglycolic acid and trimethylene carbonate mesh to reinforce the abdominal wall and a large polypropylene mesh that envelops the visceral sac and is fixed to the right pubis and the pseudocapsule of the hip prosthesis. In the postoperative period, the patient presented pulmonary thromboembolism and surgical wound infection. He was discharged on the 17th postoperative day. One year after surgery, the patient is asymptomatic, and has a continent wall with discrete lateral bulging. Preperitoneal dissection makes it possible to solve very complex wall defects, even with very large bone defects.