[Genetic architecture of anterior abdominal wall hernias]. / Geneticheskaya arkhitektura gryzh perednei bryushnoi stenki.

OBJECTIVE: To analyze genome-wide studies devoted to polymorphisms of factors of anterior abdominal wall hernias, to study the association of the most common polymorphism In Russian population. MATERIAL AND METHODS: Searching for literature data was carried out in the RSCI and PubMed databases. We enrolled national and foreign reports. The study on Russian population included 577 people. RESULTS: We found 5 genome-wide studies performed by foreign authors. We identified the loci responsible for genetic predisposition to inguinal hernias: WT1, EFEMP1, EBF2 and ADAMTS6. The Japanese scientists revealed an important role of loci TGFB2, RNA5SP214/VGLL2, LOC646588, HMCN2, ATP5F1CP1/CDKN3. In other studies, loci 1q41 (ZC3H11B), 2p16.1 (EFEMP1), 6p22.1 (MHC region), 7q33 (CALD1) and 11p13 (WT1) determined different hernias. The EFEMP1 gene polymorphism was among genes most associated with anterior abdominal wall hernias in all studies. Analysis of this polymorphism In Russian population revealed significant association with anterior abdominal wall hernias. CONCLUSION: The obtained data on target correction of DNA chains can significantly reduce the incidence of anterior abdominal wall hernias. In turn, this will significantly reduce the cost of surgical treatment and risk of complications with recurrences of hernias. Moreover, identifying the most associated polymorphisms may be valuable to determine the most appropriate surgical treatment.

Use of rainbow trout skin treated with glutaraldehyde as a mesh for abdominal hernioplasty in rats.

PURPOSE: To test the use of rainbow trout skin as a surgical mesh in abdominal hernioplasties in rats. METHODS: The experiment involved 20 Wistar rats receiving implants of trout skin processed for disinfection in 0.5% glutaraldehyde and preserved in 100% glycerin. The animals were divided into four groups, divided at 7, 15, 30, and 90 days postoperatively. Clinical and infrared thermography evaluations were performed, and after euthanasia, assessments of adhesion formations and sample collection for histological evaluation were conducted. RESULTS: The implant was observed to be intact, ensuring the integrity of the abdominal wall, support for the viscera, and normal mobility for the rats for up to 90 days. Low rates of clinical alterations were observed, with an intense inflammatory reaction up to day 7, chronic inflammation and the onset of angiogenesis at day 15, and a low inflammatory reaction with collagenous infiltrate and fibrosis at day 30. At day 90, the implants showed a collagenous and fibrotic infiltrate with a minimal inflammatory infiltrate. CONCLUSIONS: The surgical mesh of trout skin performed well, making it a potential alternative for surgical procedures in muscle aponeurotic corrections in the abdominal wall.

Specific Features of Diagnostic and Treatment Tactics in Patients with Crushed Abdominal Hernias Without Resection of a Hollow Organ.

The purpose of the work is to analyze the results of the use of optimized diagnostic and therapeutic tactics in patients with strangulated abdominal hernias without resection of the hollow organ. Materials and methods: The work is based on the analysis of the results of surgical treatment of 665 patients with strangulated abdominal hernias without resection of the hollow organ, who were divided into 2 groups depending on the features of the diagnostic and treatment tactics. Unlike the patients of group 1, the following diagnostic tactics were used in group 2: substantiated laparoscopic diagnosis of abdominal organs; mandatory biochemical assessment of hernia water; mandatory intraoperative instrumental assessment of the state of the strangulated organ; expansion of indications for the use of laparoscopic interventions and components of the comprehensive Fast track program; substantiated complex prevention of malignancy. The clinical diagnostic algorithm included laboratory, instrumental and biochemical research methods. Results: The use of priority diagnostic and therapeutic tactics in the patients of group 2 allowed to increase the number of laparoscopic hernioplasty by 49.34%, the number of allohernioplasty by 18.62%, among which the "Sublay" technique was preferred for strangulated ventral hernias. This was accompanied by a decrease in the pain syndrome on the VAS scale during the four days of observation, both during coughing and at rest, and amounted to only 2.21 ± 0.29 points on the fourth day when at rest. In addition, and after 12 months, the patients of group 2 observed a better recovery according to the SF-36 questionnaire, which amounted to 76.77±6.63 points for the assessment of the general state of health, 70.81±5.86 points for the assessment of physical functioning, 68.88±5.37 points for the assessment of role functioning due to physical condition, 68.03±5.92 points for the assessment of role functioning due to emotional state, and social activity was characterized by 72.82±5.52 points. Conclusions: 1. The proposed diagnostic and treatment tactics in the patients of group 2 with strangulated abdominal hernias without resection of a hollow organ, in contrast to patients in group 1, made it possible to increase the number of laparoscopic operations to 227 (66.37%) in contrast to 55 (17.03%) in the first group, which was accompanied by a decrease in pain syndrome on the VAS scale on the fourth day when coughing from 4.35 ± 0.38 points to 2.97 ± 0.43 points. 2. The expansion of indications for the use of laparoscopic operations in patients of group 2, in contrast to patients of group 1, led to a decrease in the postoperative complications by 10.48% and the postoperative mortality by 2.29% and was characterized by better postoperative rehabilitation according to the assessment of the patients' condition after 12 months according to the SF-36 questionnaire..

Spigelian hernia.

INTRODUCTION: Spigelian hernia is a rare type of abdominal wall hernias which are often diagnosed when incarcerated. These hernias typically develop at the crossing point of the arcuate line and lateral portion of rectus abdominis muscle. CASE REPORT: We present the case of a 44-year-old female patient admitted to our surgery unit for a painful lump in her right mesogastrium. Incarcerated atypical hernia in the right mesogastrium was suspected based on completed imaging assessments. Spigelian hernia was confirmed by preoperative findings. Interestingly, the patient applied interferon (multiple sclerosis therapy) at the site of the lump, which is why the diagnosis of lipodystrophy had been considered. CONCLUSION: In general, the diagnosis of Spigelian hernia is difficult. From the anatomical point of view the clinical finding is not always specific. The risk of incarceration is relatively high, and thus even clinically silent findings are indicated for surgery.

Diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias: a retrospective study.

INTRODUCTION: To explore the diagnostic value of high-resolution ultrasound combined with multi-slice computer tomography (MSCT) for pediatric intra-abdominal hernias (IAHs), and to analyze the potential causes for missed diagnosis and misdiagnosis of IAHs in children. METHODS: A retrospective analysis was conducted on 45 children with surgically confirmed IAHs. The diagnostic rate of IAHs by preoperative high-resolution ultrasound combined with MSCT was compared with that of intraoperative examination, and the potential causes for missed diagnosis and misdiagnosis by the combination method were analyzed. RESULTS: Forty-five cases of pediatric IAHs were categorized into primary (25/45, 55.5%) and acquired secondary hernias (20/45, 44.5%). Among children with primary hernias, mesenteric defects were identified as the predominant subtype (40%). Acquired secondary hernias typically resulted from abnormal openings in the abdominal wall or band adhesions due to trauma, surgery, or inflammation. In particular, adhesive band hernias were the major type in children with acquired secondary hernias (40%). The diagnostic rate of high-resolution ultrasound was 77.8%, with "cross sign" as a characteristic ultrasonic feature. Among 10 cases of missed diagnosis or misdiagnosis, 5 were finally diagnosed as IAHs by multi-slice computer tomography (MSCT). Overall, the diagnostic rate of pediatric IAHs by preoperative ultrasound combined with radiological imaging reached 88.9%. DISCUSSION: IAHs in children, particularly mesenteric defects, are prone to strangulated intestinal obstruction and necrosis. High-resolution ultrasound combined with MSCT greatly enhances the diagnostic accuracy of pediatric IAHs.

Fabrication of a modified bacterial cellulose with different alkyl chains and its prevention of abdominal adhesion.

Abdominal hernia mesh is a common product which is used for prevention of abdominal adhesion and repairing abdominal wall defect. Currently, designing and preparing a novel bio-mesh material with prevention of adhesion, promoting repair and good biocompatibility simultaneously remain a great bottleneck. In this study, a novel siloxane-modified bacterial cellulose (BC) was designed and fabricated by chemical vapor deposition silylation, then the effects of different alkyl chains length of siloxane on surface properties and cell behaviors were explored. The effect of preventing of abdominal adhesion and repairing abdominal wall defect in rats with the siloxane-modified BC was evaluated. As the grafted alkyl chains become longer, the surface of the siloxane-modified BC can be transformed from super hydrophilic to hydrophobic. In vivo results showed that BC-C16 had good long-term anti-adhesion effect, good tissue adaptability and histocompatibility, which is expected to be used as a new anti-adhesion hernia repair material in clinic.

UMBILICAL AND EPIGASTRIC HERNIA REPAIR: A SYSTEMATIC REVIEW.

BACKGROUND: Umbilical and epigastric hernias are among the most common hernias of the abdominal wall; however, there is a lack of standardization for their treatment. AIMS: To clarify the controversies regarding therapeutic possibilities, indications, and surgical techniques for umbilical and epigastric hernia repair. METHODS: A systematic review and qualitative analysis of randomized clinical trials published in the last 20 years, involving adults (aged 18 years and over) with umbilical and/or epigastric hernias, was performed by systematically searching the PubMed/Medline, Cochrane, SciELO, and LILACS databases. The risk of bias in individual studies was assessed using the Cochrane Risk of Bias Tool. RESULTS: Initially, 492 studies were selected and, subsequently, 15 randomized controlled clinical trials were chosen that met the inclusion criteria and underwent full reading and qualitative analysis, considering possible bias. CONCLUSIONS: This review concluded that it is evident the superiority of the use of meshes in the repair of epigastric/primary umbilical hernias with a defect larger than 1 cm, even in certain emergency situations. However, suture repair is a good option for patients with a defect smaller than 1 cm. In the laparoscopic approach, recent evidence points towards possible superiority in fixation with fibrin sealant, and fascial defect closure is recommended. In addition, due to a scarcity of randomized controlled trials with low risk of bias, further studies are needed on types, positioning and fixation techniques, as well as the real role of video-assisted laparoscopic surgery in the correction of hernias, especially umbilical.

Traumatic abdominal wall hernia in childhood: a bicycle handlebar injury.

A female patient in her middle childhood presented to the paediatric emergency room (ER) after a bicycle accident with an abdominal impact on the bicycle handlebar. On physical examination, a painful ecchymosis on the upper left quadrant was the only abnormal finding. Abdominal ultrasound showed no intra-abdominal lesions, and the patient was discharged home after 24 hours under monitoring. Nine days after the accident, she returned to the ER due to the emergence of an abdominal mass around the area of impact. Abdominal examination detected a tender non-fluctuating mass on the epigastric and left hypochondrium, and abdominal ultrasound revealed a muscle and aponeurosis disruption of the rectus muscle, with fat herniation and cytosteatonecrosis. A conservative approach was chosen, with ambulatory follow-up. One month after the accident, the patient was asymptomatic, no abdominal mass was palpable, and an abdominal CT showed a reduction of the muscle disruption and hernial content.

Durable and Robust Antibacterial Polypropylene Hernia Mesh for Abdominal Wall Defect Repair.

Polypropylene (PP) mesh is commonly used in repairing abdominal wall hernia (AWH). However, the use of synthetic prosthesis comes with the risk of developing a prosthetic infection, resulting in delayed healing, secondary surgery, and potentially increased mortality. To address these issues, a facile surface functionalization strategy for PP mesh based on phytic acid (PA) and polyhexamethylene guanidine (PHMG) was constructed through a one-step co-deposition process, referred to as the PA/PHMG coating. The development of PA/PHMG coating is mainly attributed to the surface affinity of PA and the electrostatic interactions between PA and PHMG. The PA/PHMG coating could be completed within 4 h under mild conditions. The prepared PA/PHMG coatings on PP mesh surfaces exhibited desirable biocompatibility toward mammalian cells and excellent antibacterial properties against the notorious "superbug" methicillin-resistant Staphylococcus aureus (MRSA) and tetracycline-resistant Escherichia coli (TRE). The PA/PHMG-coated PP meshes showed killing ratios of over 99% against MRSA in an infected abdominal wall hernia repair model. Furthermore, histological and immunohistochemical analysis revealed a significantly attenuated degree of neutrophil infiltration in the PA/PHMG coating group, attributed to the decreased bacterial numbers alleviating the inflammatory response at the implant sites. Meanwhile, the pristine PP and PA/PHMG-coated meshes showed effective tissue repair, with the PA/PHMG coating group exhibiting enhanced angiogenesis compared with pristine PP meshes, suggesting superior tissue restoration. Additionally, PP meshes with the highest PHMG weight ratio (PA/PHMG(3)) exhibited excellent long-term robustness under phosphate-buffered saline (PBS) immersion with a killing ratio against MRSA still exceeding 95% after 60 days of PBS immersion. The present work provides a facile and promising approach for developing antibacterial implants.

Bone Anchor Fixation in the Repair of Blunt Traumatic Abdominal Wall Hernias: A Western Trauma Association Multicenter Study.

BACKGROUND: Blunt traumatic abdominal wall hernias (TAWHs) are rare but require a variety of operative techniques to repair including bone anchor fixation (BAF) when tissue tears off bony structures. This study aimed to provide a descriptive analysis of BAF technique for blunt TAWH repair. Bone anchor fixation and no BAF repairs were compared, hypothesizing increased hernia recurrence with BAF repair. METHODS: A secondary analysis of the WTA blunt TAWH multicenter study was performed including all patients who underwent repair of their TAWH. Patients with BAF were compared to those with no BAF with bivariate analyses. RESULTS: 176 patients underwent repair of their TAWH with 41 (23.3%) undergoing BAF. 26 (63.4%) patients had tissue fixed to bone, with 7 of those reinforced with mesh. The remaining 15 (36.6%) patients had bridging mesh anchored to bone. The BAF group had a similar age, sex, body mass index, and injury severity score compared to the no BAF group. The time to repair (1 vs 1 days, P = .158), rate of hernia recurrence (9.8% vs 12.7%, P = .786), and surgical site infection (SSI) (12.5% vs 15.6%, P = .823) were all similar between cohorts. CONCLUSIONS: This largest series to date found nearly one-quarter of TAWH repairs required BAF. Bone anchor fixation repairs had a similar rate of hernia recurrence and SSI compared to no BAF repairs, suggesting this is a reasonable option for repair of TAWH. However, future prospective studies are needed to compare specific BAF techniques and evaluate long-term outcomes including patient-centered outcomes such as pain and quality of life.

Obesity and abdominal hernia in ambulatory patients, 2018-2023.

PURPOSE: To determine the relationship between abdominal hernia and obesity. Although obesity is frequently cited as a risk factor for abdominal hernia, few studies have confirmed this association (Menzo et al. Surg Obes Relat Dis 14:1221-1232. 10.1016/j.soard.2018.07.005, 2018). METHODS: A cross-sectional study of primary care ambulatory patients aged older than 16 years treated at UCLA Health from 01/01/2018 to 06/06/2023. Abdominal hernia was identified by clinic encounter ICD-10 codes (K40-K46). RESULTS: There were 41,703 hernias identified among 1,362,440 patients (306.1 per10,000) with a mean age of 62.5 ± 16.1 years, and 57.6% were men. Nearly half (44.7%) of all abdominal hernias were diaphragmatic. There was an approximately equal distribution of the ventral (28.7%) and inguinal (24.3%) hernia. Each hernia type had a different relationship with obesity: The odds of having a ventral hernia increased with BMI in both sexes: BMI 25-29.9 kg/m2 odds ratio (OR) = 1.65, (CI 1.56-1.74); BMI 30-39.9 kg/m2 OR = 2.42 (CI 2.29-2.56), BMI 40-49.9 kg/m2 OR = 2.28 (CI 2.05-2.54) and BMI > = 50 kg/m2 OR = 2.54 (CI 2.03-3.17) all relative to normal BMI. In contrast, the odds of having an inguinal hernia decreased with obesity relative to normal weight [obesity (BMI 30-39.9 kg/m2): OR = 0.60 (CI 0.56-0.65)], morbid obesity (BMI 40-49.9 kg/m2): OR = 0.29 (CI 0.23-0.37). The OR for diaphragmatic hernia peaks with obesity in women and overweight status in men but was found to decrease with morbid obesity [OR = 1.18 (CI 1.07-1.30)]. There was no significant difference between men and women in the prevalence of femoral hernia (men: 0.7/per10,000, women: 0.9/per10,000, p = 0.19). CONCLUSIONS: The relationship between hernia and obesity is complex with some hernias decreasing in prevalence as obesity increases. Further research is needed to better understand this paradoxical relationship.

Coatings for Permanent Meshes Used to Enhance Healing in Abdominal Hernia Repair: A Scoping Review.

INTRODUCTION: Hernia meshes are used to reduce recurrence and pain rates, but the rates are still high. This could be improved with coatings of the mesh. This scoping review aimed to provide an overview of mesh coatings used to promote healing in abdominal hernia repair and to report beneficial and unbeneficial effects. METHODS: We included human and animal studies with abdominal hernias that were repaired with non-commercially coated meshes. We searched Pubmed, Embase, Cochrane Central, LILACS, and CNKI without language constraints. RESULTS: Of 2933 identified studies, 58 were included: six studies had a total of 408 humans and 52 studies had 2679 animals. The median follow-up was 12 months (range 1-156), and 95% of the hernias were incisional. There were 44 different coatings which included platelet-rich plasma, mesenchymal stem cells, growth factors, vitamin E, collagen-derived products, various polysaccharides, silk proteins, chitosan, gentamycin, doxycycline, nitrofurantoin, titanium, and diamond-like carbon. Mesenchymal stem cells and platelet-rich plasma were the most researched. Mesenchymal stem cells notably reduced inflammation and foreign body reactions but did not impact other healing metrics. In contrast, platelet-rich plasma positively influenced tissue ingrowth, collagen deposition, and neovascularization and had varying effects on inflammation and foreign body reactions. CONCLUSION: We identified 44 different mesh coatings and they showed varying results. Mesenchymal stem cells and platelet-rich plasma were the most studied, with the latter showing considerable promise in improving biomechanical properties in hernia repair. Further investigations are needed to ascertain their definitive use in humans.

Fibroblast matrix implants-a better alternative for incisional hernia repair?

The standard surgical procedure for abdominal hernia repair with conventional prosthetic mesh still results in a high recurrence rate. In the present study, we propose a fibroblast matrix implant (FMI), which is a three-dimensional (3D) poly-L-lactic acid scaffold coated with collagen (matrix) and seeded with fibroblasts, as an alternative mesh for hernia repair. The matrix was seeded with fibroblasts (cellularized) and treated with a conditioned medium (CM) of human Umbilical Cord Mesenchymal Stem Cells (hUC-MSC). Fibroblast proliferation and function were assessed and compared between treated with CM hUC-MSC and untreated group, 24 h after seeding onto the matrix (n= 3). To study the matricesin vivo,the hernia was surgically created on male Sprague Dawley rats and repaired with four different grafts (n= 3), including a commercial mesh (mesh group), a matrix without cells (cell-free group), a matrix seeded with fibroblasts (FMI group), and a matrix seeded with fibroblasts and cultured in medium treated with 1% CM hUC-MSC (FMI-CM group).In vitroexamination showed that the fibroblasts' proliferation on the matrices (treated group) did not differ significantly compared to the untreated group. CM hUC-MSC was able to promote the collagen synthesis of the fibroblasts, resulting in a higher collagen concentration compared to the untreated group. Furthermore, thein vivostudy showed that the matrices allowed fibroblast growth and supported cell functionality for at least 1 month after implantation. The highest number of fibroblasts was observed in the FMI group at the 14 d endpoint, but at the 28 d endpoint, the FMI-CM group had the highest. Collagen deposition area and neovascularization at the implantation site were observed in all groups without any significant difference between the groups. FMI combined with CM hUC-MSC may serve as a better option for hernia repair, providing additional reinforcement which in turn should reduce hernia recurrence.

A Rare Case of Small Bowel Obstruction in a 15-Year-Old Girl: Internal Hernia Associated with Meckel's Diverticulum.

BACKGROUND Meckel's diverticulum is a congenital remnant of the omphalomesenteric duct and is the most common congenital gastrointestinal malformation. Most patients are asymptomatic, but a rare presentation is with subacute small bowel obstruction (SBO) due to herniation of bowel loops through an internal hernia formed by the Meckel's diverticulum and adjacent mesentery that forms an internal hernia. This report is of a 15-year-old girl presenting as an emergency with vomiting and small bowel obstruction due to an internal hernia associated with Meckel's diverticulum. CASE REPORT We present a case of a 15-year-old girl who presented to the Children's Emergency (CE) department with persistent vomiting and abdominal distension and tenderness. X-rays demonstrated dilated small bowel loops, prompting admission under Pediatric Surgery (PAS). A subsequent computed tomography (CT) scan was performed, which demonstrated multiple dilated small bowel loops, confirming SBO, and a blind-ending "C-shaped" bowel loop at the region of the terminal ileum. A diagnostic laparotomy was performed, which confirmed the presence of a Meckel's diverticulum. The tip of the Meckel's diverticulum was adherent to part of the small bowel mesentery, forming an internal hernia defect through which a loop of proximal ileum had herniated, resulting in SBO. She then underwent a laparoscopy-assisted transumbilical Meckel's diverticulectomy (LATUM). The patient recovered uneventfully and was discharged on the 4th postoperative day. CONCLUSIONS In children presenting with SBO, the possibility of Meckel's diverticulum as an etiology should be considered as a differential diagnosis. Early diagnosis and prompt intervention will improve clinical outcomes and avoid complications.

Preoperative optimization in hernia surgery: are we really helping or are we just stalling?

BACKGROUND: Managing patients with abdominal wall hernias and multiple comorbidities can be challenging because these patients are at increased risk for postoperative complications. Preoperative optimization has been used to identify and intervene upon modifiable risk factors to improve hernia repair outcomes, however, waiting to achieve optimization may cause unnecessary delays. METHODS: We describe our approach to preoperative optimization in hernia and we review the current evidence for preoperative optimization. CONCLUSION: Modifying risk factors before undergoing elective hernia repair can improve the overall health of patients with multiple comorbidities. However, when considering the hernia-specific data, prolonging waiting times for patients to achieve full optimization is not justified. Surgeons should take a nuanced approach to balance achieving patient optimization without unnecessarily delaying surgical care.

"Slim-Mesh" Technique for Diastasis Recti Abdominis, Including Obesity-Related Cases.

Background and Objective: We operated on a series of mostly obese patients with diastasis recti abdominis using the "Slim-Mesh" technique to repair/reinforce the diastasis and linea alba/recti muscles without plicating and traumatizing them. Additional objectives were to decrease operation time and intra- and postoperative complications. Methods: We considered T1 cases diastasis after pregnancy and T2 cases obesity (BMI ≥ 30 mg/kg2); D1, D2, and D3 when the diastasis measured 2-3, 3-5, and ≥ 5 cm, respectively; H0 and H1 without and concomitant umbilical and/or epigastric hernia, respectively. At our Department, between May 2010 and November 2022, 47 patients with diastasis recti were operated on with the "Slim-Mesh" technique to reinforce/repair the traumatized linea alba/recti muscles, without plicating them. This was a prospective (83%)-retrospective study. Results: We studied 23 males and 24 females. Mean age and BMI was 58 years and 29 kg/m2, respectively. Groups D1, D2, and D3 comprised 6, 23 and 18 patients, respectively; groups T1, T2, H0 and H1 comprised 22, 25, 13 and 34 patients, respectively. Mean operation time for all cases was 100 minutes. Mean length of hospital stay was 2.3 days and follow-up time was 5 years. We had 6 late postoperative complications: 3 hernia recurrences and 3 trocar site hernias. Conclusion: Considering the lack of agreement on the best surgery for diastasis recti abdominis repair, in our experience the "Slim-Mesh" technique is a valid, safe and easy-to-reproduce way to save, repair and reinforce linea alba/recti muscles in diastasis recti patients, including the obese population (53%).

Management of a primary Grynfeltt's hernia.

Lumbar hernia is a rare disease, which can be acquired spontaneously or secondarily (post-traumatically, postoperatively…) or congenitally. It results from the existence of areas of weakness between the different muscles forming the posterior abdominal wall: the deep-seated Grynfeltt triangle and the superficial Jean-Louis Petit triangle.

Toxina botulínica y neumoperitoneo secuencial en el manejo de hernia inguinoescrotal gigante: Reporte de caso / Botulinum toxin and sequential pneumoperitoneum in the management of giant inguinoscrotal hernia: Case report

Introducción. Las hernias gigantes con pérdida de domicilio son aquellas cuyo saco herniario alcanza el punto medio del muslo en bipedestación y su contenido excede el volumen de la cavidad abdominal. Estas hernias son un reto quirúrgico dada la difícil reducción de su contenido y del cierre primario de la fascia. Tienen mayor riesgo de complicaciones asociadas al síndrome compartimental abdominal, así como mayor tasa de recurrencia y morbilidad en los pacientes. Caso clínico. Paciente masculino de 81 años, reconsultante por hernia inguinoescrotal derecha gigante, de dos años de evolución, sintomática, con índice de Tanaka de 24 %. Se decidió aplicar el protocolo de neumoperitoneo secuencial (hasta 11.000 ml en total en cavidad) además de toxina botulínica en pared abdominal (dos sesiones). Resultados. Se logró la corrección exitosa de la hernia inguinoescrotal gigante, sin recaídas de su patología abdomino-inguinal. El paciente manifestó satisfacción con el tratamiento un año después del procedimiento. Conclusiones. El protocolo de neumoperitoneo secuencial es una alternativa en casos de hernias complejas, con alto riesgo de complicaciones, que requieren técnicas reconstructivas adicionales. La aplicación previa de toxina botulínica es un adyuvante considerable para aumentar la probabilidad de resultados favorables. Sin embargo, debe incentivarse la investigación en esta área para evaluar su efectividad.

Introduction. Giant hernias with loss of domain are those whose hernial sac reaches the midpoint of the thigh in standing position and whose content exceeds the volume of the abdominal cavity. These hernias are a surgical challenge given the difficult reduction of their contents and the primary fascial closure, with a higher risk of complications associated with abdominal compartment syndrome, as well as a higher rate of recurrence and morbidity in patients. Clinical case. A 81-year-old male patient with comorbidity, reconsulting due to a symptomatic giant right inguinoscrotal hernia of two years of evolution, with a Tanaka index of 24%, eligible for a sequential pneumoperitoneum protocol (up to a total of 11,000 cc in cavity) plus application of botulinum toxin (two sessions) in the abdominal wall. Results. Successful correction of the patient's giant inguinoscrotal hernia was achieved using this protocol, without recurrence of his abdomino-inguinal pathology and satisfaction with the procedure after one year. Conclusion. The sequential pneumoperitoneum protocol continues to be an important alternative in cases with a high risk of complications that require additional reconstructive techniques, while the previous application of botulinum toxin is a considerable adjuvant to further increase the rate of favorable results. However, research in the area should be encouraged to reaffirm its effectiveness.