N 5 (196) 2025. P. 66–72

A CASE REPORT: ABDOMINAL WALL RECONSTRUCTION FOR A THIRD-TIME RECURRENT GIANT VENTRAL HERNIA WITH LOSS OF DOMAIN

O. P. Laver, B. M. Patskan

State University “Uzhhorod National University”, Uzhhorod, Ukraine
Uzhhorod City Multidisciplinary Clinical Hospital, Uzhhorod, Ukraine

Introduction. Giant ventral hernias with loss of domain (LoD) pose significant challenges in abdominal surgery due to irreducibility, scar tissue, and the risk of abdominal compartment syndrome. According to the European Hernia Society (EHS) giant hernias are defined as defects

> 10 cm. Traditional hernioplasty methods without tissue preparation are associated with high recurrence rates (30–80%)

Aim. To present a case of successful abdominal wall reconstruction in a patient with a three-times recurrent giant ventral hernia with LoD using a combined approach involving botulinum toxin injections, progressive pneumoperitoneum, bone anchor fixation, two polypropylene meshes, and to evaluate the effectiveness of this method.

Materials and methods. The case involved a 69-year-old female patient with a giant third time recurrent ventral hernia with a defect size 30×35 cm classified as W3 M3 R with LoD. Methods included anamnesis history collection, physical examination, preoperative and 6-month postoperative CT control, intraoperative photo documentation. Preoperative preparation involved weight loss, lateral abdominal muscle relaxation with Dysport (botulinum toxin A) and progressive pneumoperitoneum. Intraoperational implantation of two Covidien Parietene 30×45 cm macroporous meshes and Smith & Nephew 4×8 mm titanium bone anchors. Procedures adhered to the ethical principles of the World Medical Association (Helsinki Declaration), with informed consent obtained.

Conclusions. The combined approach achieved stable abdominal wall reconstruction without recurrence over 6 months. Botox, pneumoperitoneum, TAR, and two mesh implants with bone anchors proved effective for complex hernias, though further studies are needed for long-term validation.

Keywords: ventral hernia, loss of domain, botulinum toxin, pneumoperitoneum, mesh implant.

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