Treatment of a massive incisional abdominal wall hernia requiring subtotal colectomy using a dual facing mesh

Summary

A case report of a giant abdominal wall defect in a 62-year-old woman is reported. Diabetes and severe overweight (BMI: 52) were noted as associated risk factors. Previous surgical treatment had been performed in 1982 using a retromuscular polypropylene mesh. This treatment failed in 1998. Preoperative medical treatment was started 8 months before for skin infection. Progressive pneumoperitoneum was used to create a space to accommodate herniated viscera and facilitate fascial repair with minimal tension. To palliate the parietal defect, we used a new mesh placed intraperitoneally. This mesh was made up of a dual facing mesh combining a three-dimensional polyester covered on one of its sides with an adhesion-preventive, hydrophilic and absorbable film (Parietex® Composite-Sofradim). The borders of the defect were individualized by total excision of the hernial sac. A subtotal colectomy with handsewn ileocolic anastomosis had to be performed to allow for reintroduction of the small bowel into the cavity. The omentum was used as a complementary barrier to cover the abdominal viscera as well as the ileocolic anastomosis. Two 20 × 25 cm meshes were juxtaposed to ensure a very broad parietal application and secured on the posterior abdominal sheath. A dermolipectomy completed the procedure, after closing the anterior wall without tension. No parietal complication was noted and the patient recovered normal activity within 2 months. In view of the good results found in the literature of intraperitoneal mesh placement, this new mesh should be considered as a very useful approach to large incisional abdominal hernia.