A Case Report of Primary Complex Ventral Hernia Repair with Loss of Domain in a Patient with Respiratory Compromise: Challenges and Insights
Shaunak Tuvar *
Jehangir Hospital and Medical Centre, Pune, India.
Pradeep Sharma
Jehangir Hospital and Medical Centre, Pune, India.
*Author to whom correspondence should be addressed.
Abstract
Primary ventral hernias (PVH) are congenital defects resulting from weaknesses in the abdominal wall. Complex ventral hernias, typically larger than 10 cm, involve a loss of domain (LOD), reducing abdominal cavity volume. This case report discusses a 62-year-old woman with a large right anterolateral complex ventral hernia that grew over 10 years, showing a 26% loss of domain on imaging.According to EHS guidelines, the case was classified as M2, M3, M4, L2, and W2. She had a BMI of 32. Due to her pre-existing respiratory conditions, including Interstitial Lung disease and Asthma, she was not a candidate for Botulinum toxin therapy. A multi-disciplinary team involving the Chest Physician, Anaesthetist, and Surgeon decided to carry out the Surgery under Epidural anaesthesia, which included Hernia reduction, Adhesiolysis, Posterior component separation, and Transversus abdominis release (TAR) with mesh reinforcement. Postoperative ICU monitoring was carried out for respiratory issues. This case demonstrates the successful management of large ventral hernias in high-risk respiratory disease patients with tailored anaesthesia and surgical methods.
Keywords: Primary hernia, loss of domain, complex ventral hernia, hernia with respiratory disease