[Complicated extremely large hernias. The technical problems]

The surgical repair of giant hernias is a serious problem. To return the viscera that are contained within the hernia sac, to the abdominal cavity, we can cause an increase of abdominal pressure, that influences the motion of the diaphragm. In fact, post-operative acute respiratory failure is always possible, in these patients. To have a good operation, the preoperative preparation by physiotherapy is very important, it helps the patient to utilize at most his pulmonary capacity. In the surgical repair of these cases, it is necessary to increase the volume of the abdominal cavity by some different techniques, in order that the intra-abdominal pressure does not increase too much. The reabsorbable prosthesis is placed in direct contact with viscera and fixed to the peritoneum and posterior rectus sheaths, so that it allows to increase the volume of the abdominal cavity. Dacron mesh is fixed to fascia and muscles and assures a long-time contentitive function. To choose the right operation depends on every single case, so the techniques are different and they often can not be codified. In the text there are described three complicated cases and the surgical repair that has been used. The last case describes a personal techniques that uses two prosthesis to create a new peritoneal cavity and a new pre-peritoneal space. The results obtained let us say that the surgery which has a functional base and the alloplastic prostheses have permitted to operate some clinical cases very difficult.