[Perioperative management of a patient with bilateral inguinal hernia and loss of "domain"]

Area of Science:

• Surgical Innovation
• Abdominal Wall Reconstruction
• Hernia Surgery

Background:

• Giant inguinal hernias are rare, complex surgical challenges, often resulting from delayed treatment.
• High complication rates, particularly abdominal compartment syndrome, necessitate careful preoperative management.
• Loss of domain in giant hernias complicates repair and increases surgical risk.

Purpose of the Study:

• To evaluate the effectiveness of preoperative preparation and staged surgical repair for giant bilateral inguinal-scrotal hernia with significant loss of domain.
• To demonstrate a method for preventing abdominal compartment syndrome in these complex cases.
• To present an original surgical technique for preperitoneal anterior abdominal wall replacement.

Main Methods:

• Preoperative preparation included adaptation to hypoxia through aerobic exercise.
• A two-stage surgical repair using a preperitoneal anterior abdominal wall replacement technique (RF patent No. 2307601) was performed.
• Management focused on preventing abdominal compartment syndrome and minimizing postoperative complications.

Main Results:

• The staged surgical approach combined with preoperative adaptation successfully managed a giant bilateral inguinal-scrotal hernia with 26.3% loss of domain.
• The method effectively adapted the patient to induced hypoxia, preventing abdominal compartment syndrome.
• Reduced incidence of postoperative complications was observed.

Conclusions:

• Two-stage preperitoneal anterior abdominal wall replacement is an effective treatment for giant hernias.
• Preoperative aerobic exercise aids in patient adaptation, mitigating risks associated with large hernia repair.
• This combined approach offers a safe and effective strategy for managing complex giant inguinal hernias.