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Abstract A 42-year-old gentleman presented with recurrent incisional hernia (M1-M4W3R1). He underwent transversus abdominis release with posterior component separation (TAR with PCS) one year ago. In the immediate postoperative period after TAR with PCS, he developed abdominal compartment syndrome (ACS). Due to ACS, the surgical team opened his midline skin sutures and anterior rectus sheath, and applied negative pressure wound therapy. Eventually, the wound healed by secondary intention. On examination, there was a wide irregular scarring at the previous wound site, along with a hernial defect of approximately 20 × 20 cm in size. He underwent a CECT abdomen, which revealed a 20 × 20 cm defect along with a loss of domain. We initially instituted the botulinum-A injection into his lateral group of abdominal wall muscles. However, we could not achieve the desired results after botulinum injection. Therefore, we switched to preoperative progressive pneumoperitoneum to increase the abdominal cavity volume. Afterwards, we scheduled him for anterior component separation (ACS). In addition to ACS, we had to preserve the peritoneal sac to facilitate midline closure. We then placed an onlay polypropylene mesh and closed the skin. During a 6-month follow-up, the patient is doing well.
Kumar et al. (Wed,) studied this question.