Tailored Approach to Abdominal Wall Reconstruction: Lessons From a Complex Hernia Case

Background Complex abdominal hernias present challenges in surgical practice, necessitating innovative strategies for successful reconstruction of the abdominal wall. We aim to elucidate the intricacies of reconstructing the abdominal wall in a complex hernia case, addressing preoperative considerations, intraoperative techniques, and postoperative outcomes. Method Presentation of a case of complex abdominal hernia through the case description, presentation of complementary diagnostic exams, and photographic documentation of the surgical steps. Results We present the case of a 49-year-old male patient with a history of obesity and multiple surgical interventions due to anorectal agenesis, including a previously closed colostomy. He was referred to our center due to a complex incisional hernia. Clinical examination and CT imaging revealed an umbilical hernia (M3W1, European Hernia Society Classification (EHSc)), and a left paramedian hernia (M3M4W3, EHSc), along with multiple retracted scars. The patient underwent a preoperative preparation program for obesity and abdominal wall prehabilitation with Botulinum Toxin. Four weeks after, he underwent abdominal wall reconstruction via laparotomy. The reconstruction involved posterior wall repair using the "small bites" technique, placement of a self-gripping mesh in a sublay position, and closure of the anterior aponeurosis using the same technique. The recovery proceeded without complications, and the patient was discharged on the 3th postoperative day. Conclusion This case highlights the importance of a thorough diagnostic and surgical approach in managing complex abdominal hernias. It also emphasizes the need for individualized preoperative strategies and advanced surgical approaches to ensure favourable outcomes for patients with complex abdominal hernias.