P-126 Giant Umbilical Hernias: Emergency Surgical Treatment and Definitive Surgery. A Clinical Case

Abstract

Aim Complex hernias with loss of domain are a challenge for the surgeon, especially when presenting with complications in the emergency room. The emergency treatment differs from definitive surgery, as the patient's scenario is very different and they often present hemodynamic instability, intestinal perforation, etc.. Clinical Case 58-year-old male patient who underwent emergency surgery for septic shock due to intestinal perforation secondary to intestinal occlusion from a primary umbilical hernia, with loss of domain. Through a median laparotomy on the hernia, intestinal resection was performed. Abdominal wall closure wasperformed directly with the hernia sac, without abdominal wall repair. The patient was discharged for outpatient follow up. We planned the definitive surgery. Prehabilitation of the patient begins with botulinum toxin infiltration one month prior to surgery and by creating a progressive pneumoperitoneum. The definitive surgical procedure consists in performing retromuscular umbilical hernioplasty with a posterior component separation technique with placement of four 30×30 cm polypropylene meshes in the retromuscular space and closure of the anterior wall, associated with dermolipectomy. The patient evolved favorably and was discharged. Conclusions The treatment of this type of hernia in the emergency room must be personalized in each case, prioritizing damage control, and followed up by a definitive repair of the hernia. For this repair, it is advisable to perform prehabilitation with botulinum toxin, associated or not, with progressive pneumoperitoneum depending on the characteristics of the patient and the hernia, to avoid an increase in intra-abdominal pressure and the consequent compartment syndrome.