Aim To analyze the treatment and complications of gigant paraestomal eventration with a case report and literatura review Material and Methods a retrospective case report from our hospital and her evolution since her urology surgery in 2011 Results Female of 59 years old, with personal antecedents of arterial hypertension, simple cistectomy and Bricker's urinary derivation (cutaneus ureteroileostomy) in 2011 due to intersticial cistitis, parastomal incisional hernia repair with intraperitoneal mesh in 2015. The patient was derivated from urology consult for a huge paraestomal incisional hernia and personal history of obstructive uropathy and several infections of urinary tract since 2022. No obstruction clinic was associated. Elective surgery was performed with an Trasversus Abdominis Release (TAR) and moving previous urostoma: hernial sac disection and previous mesh explant. Opening Rives, Retzius spaces and transversus fasciotomy was realized. Middle line was reforzed and hernial defect was closed. Polipopilene mesh was fixed at middle line and pubis with no reabsorbible suture and reforced with haemosthatic sealant. Anterior fascia was closed fixing at middle line. At the end a new urostoma was made in ryght hypocondrium. In postoperative period the patient developed light anaemia. Following months, the patient has not other complications due to incisional hernia repair. Conclusions Many factors can contibute to incisional hernia such as obesity, hypertension, number of surgerys, age, sex… TAR technique can be useful with complex eventration but we can not forget the commorbilities association to this surgery (anemia, pulmonar Tromboembolism…)

Aim To Show the management of skin necrosis, wound dehiscence and mesh infection in a patient undergoing TAR (Transversus Abdominis Muscle Release) through NPT (Negative Pressure Therapy) Material and Methods A 55-year-old man underwent elective surgery in 2017 for a giant hydatid cyst with portal rupture during the intervention, making a subcostal incision and subsequently midline laparotomy. Subsequently, he developed portal cavernomatosis and portal hypertension. In 2018, he underwent surgery for incisional hernia in a patient with a complex abdominal wall (extended subcostal incision + median laparotomy) performing a RIVES-type hernia repair. Develops chronic wall infection, mesh rejection and hernia recurrence that required reoperation with TAR (polypropylene mesh). One month after the intervention, he presents skin necrosis, wound infection and mesh infection in the upper third of the wound, which was managed through TPN cures for a year and a half. Results Given the dehiscence in the upper third of about 15×7 cm, conservative management was decided with cures and debridement of non-viable tissue. In contact with the polypropylene mesh, a silver dressing was applied, as well as treatment with negative pressure therapy. This cure was carried out for a year and a half every 3–4 days, being able to cover the mesh with granulation tissue and close it by secondary intention, thus avoiding a reintervention with mesh explant. Conclusions TPN is a useful tool in the management of mesh infections in patients with complex abdominal wall, thus avoiding reintervention and mesh explantation.

Aim To analyze the results of patients with complex abdominal wall surgery using TAR(transversus abdominis muscle release) technique in our center. Material and Methods An observational, descriptive, retrospective study of patients operated using TAR technique in a second level hospital in the last three years was carried out. Demographic variables, classification of incisional hernias according to the EHS(European Hernia Society), and complications after the intervention were recorded. Statistical analysis was performed with IBMSPSS-Statistics-25. Results 13 patients were operated using TAR. Medium age was 56 years. 54% of patients were men and 46% women. Median BMI was 30. According to the EHS classification, the most frequent incisional hernia was M3(84.6%), followed by M4(61.5%) and M2(53.8%). W2(61.5%) and W3(30.8%). Median distance between the rectus in the CT prior the intervention was 85 mm. 100% had median laparotomy. 53.8% subcostal or stomal incision. 46% of the patients suffered some type of complication, 38.5% surgical. The complications were wound dehiscence secondary to skin necrosis(23%), abscess(15%), mesh infection(7%), hematoma(7%). Recurrence(7%). Subcostal or other laparotomy showed higher risk of complications of any type(p 0,048). Distance between rectums was associated with high risk of skin necrosis and wound dehiscence(p 0,015). No ileus, UTI, pneumonia, stroke or DVT. Conclusions TAR is a technique used in complex abdominal wall with good results in relation to closure of hernia defect. However, in our cohort some postoperative complications were observed with a low rate of hernia recurrence. This highlights the effectiveness of TAR as a technique for complex abdominal wall closure.

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