Surgery for incisional hernia with loss of domain complicated by morbid obesity: A case report

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Abstract Radical surgery for abdominal wall incisional hernia with loss of domain (LOD) has a high incidence of postoperative complications and recurrence, and there is no consistent consensus on the surgical approach. This article reports the surgical management of an incisional hernia with LOD complicated by morbid obesity. A 70-year-old female with a body mass index of 40.4 kg/m 2 was admitted to our hospital owing to severe abdominal pain. She had an adult-head-sized incisional hernia in the lower abdomen and an incarcerated intestine extending from the ileum to the transverse and sigmoid colons in the hernial sac. After 1 month of diet and exercise therapy prior to surgery, elective herniorrhaphy was performed. Intraperitoneal onlay mesh repair was used, and postoperative intensive care was provided to manage subsequent abdominal compartment syndrome (ACS). She was discharged on postoperative day 22 without morbidity. Three years postoperatively, no recurrence was observed. Careful perioperative strategies of surgical procedure and intensive management to prevent the progression of ACS are essential for optimal outcomes in LOD hernia complicated by morbid obesity.

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