Use of Progressive Preoperative Pneumoperitoneum on a Patient With a Complex Incisional Hernia

Abstract The incidence of complex incisional hernias is increasing due to increasing number of major abdominal surgeries being performed, damage control surgery with open abdomen, and delayed abdominal wall closure. Also advances in intensive care, an ageing population, and the obesity epidemic are influencing the number of complex incisional hernias. Incisional hernia repair has evolved steadily over time, from open onlay mesh techniques or open IPOM to gold-standard Rives-Stoppa hernioplasty, and minimally invasive laparoscopic procedures to component separation techniques recently for very big hernias. At the same time, due to the inadequate results of modified surgical techniques and mesh placement methods in complex incisional hernias, new methods of extending the length of the abdominal wall emerged. These extension methods are progressive preoperative pneumoperitoneum (PPP), tissue expanders, and botulinum toxin A (BTA). In this article, we report our experience with the use of BTA, PPP, and the transversus abdominis release separation technique (TAR) on a patient with a complex incisional hernia with loss of domain. In our opinion, PPP should be considered in conjunction with BTA for incisional hernias with loss of domain, as it may facilitate primary closure, reintroduction of hernia sac contents into the abdomen, and reduction of complications after surgery.