Morbid Obesity and Complex Ventral Hernia After Progressive
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In high-volume centers where a well-experienced team is available, synchronous bariatric surgery and complex ventral hernia repair should be carried out. The combined administration of botulinum toxin A and preoperative progressive administration of pneumoperitoneum is helpful.

The worldwide increase in morbidly obese patients with complex hernia raises controversies in the choice of the appropriate treatment timing. The researchers report an innovative tailored surgical treatment carried out at their Institution.

The approach provided the injection, 6 weeks before surgery, of 500 IU of botulinum toxin A on either side of the large abdominal wall muscles. Four weeks before surgery, pneumoperitoneum was inducted and out-patient daily sessions of progressive insufflation with ambient air were then carried out. Surgery was scheduled 48 days after the botulinum injection. Sleeve gastrectomy and simultaneous posterior component separation with transversus abdominis release were performed. Two prosthetic meshes were placed sublay.

At a 1-year follow-up, no hernia recurrence was recorded while total body weight loss was 31%.

In particular, synchronous bariatric surgery and complex ventral hernia repair should be approached in high-volume centers where a consolidated experience of multidisciplinary teamwork is available. Combined botulinum toxin A and preoperative progressive pneumoperitoneum administration allow for a safe resolution of loss of domain.

Indian Journal of Surgery
Source: https://doi.org/10.1007/s12262-021-02764-8
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