Complex ventral hernias pose a significant surgical challenge, particularly those with large defects or loss of domain. Traditional techniques may be associated with high complication rates or insufficient defect coverage. The modified Carbonell-Bonafé anatomical component separation (ACS) technique offers an innovative approach to achieve tension-free closure and functional abdominal wall reconstruction. We report the case of a 44-year-old woman with a giant recurrent ventral hernia (European Hernia Society (EHS) classification M2-4 W3 R6), a history of 11 previous abdominal surgeries, and a 16 × 18 cm defect confirmed on computed tomography (CT). A two-stage surgical approach was chosen: preoperative progressive pneumoperitoneum followed by hernia repair using mesh and the modified Carbonell-Bonafé ACS technique. This method allowed tension-free closure with minimal soft tissue disruption. The patient recovered uneventfully, and imaging at four months confirmed no recurrence. The Carbonell-Bonafé technique was selected due to its advantages in preserving perforator vessels, minimizing wound complications, and allowing safe closure of large and recurrent hernias. Its incorporation of prosthetic reinforcement and preoperative pneumoperitoneum makes it especially valuable for complex cases. This report illustrates the technique's effectiveness and educational relevance for surgeons managing similar challenging scenarios. This case highlights the clinical utility of the modified Carbonell-Bonafé, which represents a safe and effective tool for reconstructing complex abdominal wall defects, expanding surgical options for giant and recurrent ventral hernias. This approach minimizes wound complications and preserves skin vascularization, enhancing functional recovery compared to traditional methods.
Cruz et al. (Thu,) studied this question.