A Hybrid Approach to Abdominal Wall Repair in M2-3w2 Hernia With Crohn´s History

Objective This presentation aims to showcase the case of a 68-year-old male with fistulizing Crohn's disease and a history of two prior surgeries involving ileocecal resection and resection of enterocutaneous fistulas. The main objective is to emphasize the benefits of a hybrid approach (combining laparoscopic and open surgery) in repairing certain incisional hernias resulting from extensive abdominal surgeries. Materials and Methods Preoperative evaluation included abdominopelvic CT and Botox administration for abdominal wall prehabilitation. The surgical intervention utilized a hybrid approach, incorporating laparoscopic eTEP for intrabdominal adhesion release, retrorectal space dissection, unilateral TAR, and closure of the posterior plane to isolate viscera from the mesh. Open surgery followed for the placement of a 30 × 30 cm polypropylene mesh and closure of the anterior aponeurosis. Results The video presents the clinical case, displaying preoperative tests, essential surgical steps, and postoperative outcomes with photographs and a follow-up computed tomography at 6 months. Through this, we aim to highlight the benefits of the hybrid approach, emphasizing its advantages in terms of laparoscopic dissection time and concluding with open surgery for mesh placement and aponeurotic closure. This proves especially valuable in cases where excessive tension might impede laparoscopic closure or necessitate the removal of redundant skin flaps. Conclusion This presentation advocates for the hybrid approach, highlighting its advantages in laparoscopic dissection time, convenient mesh placement, and the ability to address excessive tension and skin redundancy, making a compelling case for its application in specific scenarios.