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Abstract Background We present the case of a 38-year-old man with a giant incisional hernia, related to multiple abdominal surgeries and Staphylococcus aureus infection, for more than 5 years. This pathology is more unusual and very challenging in terms of surgical management. Material and Methods The computer tomograf (CT) and measurements showed that we have a case of loss of domain. Physical examination revealed a giant, irreducible incisional hernia. The purpose of the complex hernia was to eliminate Staphylococcus aureus infection, repair the incisional hernia defect, strengthen the abdominal wall, prevent recurrences and recover the functionality of the abdominal wall. We treated the incisional hernia using a combined approach consisting of: surgical mesh excision, antibiotic treatment, Botox injection after three months, pneumoperitoneum (PPP) one month after Botox injection and the transversus abdominis release procedure (TAR). We performed separation of the posterior components obtaining a large retromuscular space. After reduction of the incisional hernia, the abdominal wall was reconstructed by placing a large 50/50 cm macroporous polypropylene mesh, in the retromuscular space created by the TAR. Results The patient was discharged on the eighth postoperative day. At three-month follow-up, the patient had no recurrence of hernia, chronic pain, or other complications. The patient also noticed a significant improvement in his quality of life. Conclusion This case represents a successful combined approach of surgery, Botox, and PPP to treat a complex incisional hernia in a 38-year-old man with good results.
Продан et al. (Wed,) studied this question.