Planned Ventral Hernia After Open Abdomen Therapy: Complex Incisional Hernia Repair

Background A planned ventral hernia after open abdomen therapy is a rare hernia entity because the fascial closure rate has been increased due to established concepts for open abdominal treatment. Nevertheless, fascial closure is not always successful, and a planned ventral hernia has to be treated later. Preoperative optimisation and planning are essential for such challenging abdominal wall repairs. Methods In a single centre retrospective analysis, all incisional hernias from 2013 to 2023 (n = 632) were identified and planned hernias after a laparostomy were selected (n = 11). The data on surgical management were obtained from the patient files for the operation reports. Literature search was conducted with PubMed (Medline). Results In all cases a physical examination, abdominal sonography, CT abdomen and a colonoscopy were carried out preoperatively. The median size of the abdominal wall defects were horizontally 13 cm (6-35 cm) and vertically 18 cm (10-28 cm). Botulinum toxin A has been used preoperatively since 2018. Median fascial closure was successful intraoperatively in all 11 patients. The surgical techniques included sublay, IPOM, sandwich technique, intraoperative fascial traction, and component separation. Conclusion Planned ventral hernias after open abdomen treatment should always be considered complex hernias for which the entire expertise in hernia surgery is required. Comprehensive preoperative optimisation with botulinum toxin A infiltration is essential to facilitate anatomically appropriate reconstruction through midline closure with mesh augmentation.