CURRENT TREATMENT STANDARDS OF COMPLEX, LARGE SIZED INCISIONAL HERNIAS

There is yet no generally accepted incisional hernia classification.This article highlights practical issues of classification, treatment modalities, and multidisciplinary decision-making. We summarized many existing classifications of hernia and suggested the classification that facilitates pre-operative, intra and postoperative planning. Progressive Preoperative Pneumoperitoneum effectively helps to overcome postoperative respiratory complications. For big defects, we use Botox injections in according to Thomas Ibarra-Hurtado method one month prior to surgery. Rives-Stoppa procedure is a golden standard in incisional hernia repair. Component Separation (anterior and posterior) gives good results as well. It maintains flexibility of anterior abdominal wall. We prefer to cover relaxing incisions after CS on newly formed midline with triple sheet of mesh. It prevents recurrences in the mentioned areas. Treatment of giant hernias needs surgeons high experience in the field and multidisciplinary approach. Management of this kind of hernias should be done in specialized Hernia Centers.