Original Article Elmer Press J Clin Med Res • 2009;1(4):226-229 Management of Giant Ventral Hernia by Polypropylene Mesh and Host Tissue Barrier: Trial of Simplification Samir A. Ammar Abstract Background: Surgical management of giant ventral hernias is a surgical challenge due to limited abdominal cavity. This study evaluates management of giant ventral hernias using polypropylene mesh and host tissue barrier after suitable preoperative preparation. Methods: In the period from January 2005 and January 2007, 35 patients with giant ventral hernias underwent hernia repair. After careful preoperative preparation, repair was done using polypropyl- ene mesh. The mesh was separated from the viscera by a small part of the hernia sac and the greater omentum. Results: The average age of the patients was 52. Twenty patients had post-operative incisional and 15 had para-umbilical hernias. The mean hernia defect size was 16.8 cm. Mean body mass index was 33. Follow up ranged from 18-36 months. No patient required ventilation after operation. Recurrent seroma, which responded to repeated aspiration, was experienced in 4 patients. Minor wound infection was observed in 5 patients. Small hernia recurrence oc- curred in one patient. Conclusions: The use of polypropylene and host tissue barrier af- ter suitable preoperative preparation is relatively simple, safe, and reliable surgical solution to the problem of giant ventral hernia. Keywords: Hernia repair; Giant ventral hernia; Polypropylene mesh Introduction The management of giant hernia with loss of abdomi- Manuscript accepted for publication September 8, 2009 Surgery Department, Assiut University Hospitals, El Gamma Street, Assiut, Egypt. Email: microsurg1@gmail.com doi:10.4021/jocmr2009.10.1268 nal domain remains a surgical challenge. Loss of abdomi- nal domain occurs when the intra-abdominal contents can no longer lie within the abdominal cavity [1]. Giant ventral hernias are considered in cases where the hernia orifice is greater than 10 cm [2]. Huge hernias are more liable to com- plications and poorly controlled by external support. There are many problems associated with the management of such giant hernias. Firstly reduction of the contents is difficult. Postoperative disorders in the cardiovascular system, tissue oxygenation, increased intra–abdominal pressure, and pul- monary embolism expose the patient to severe risks [3, 4]. As the hernia is large, the risk of recurrence is high. Lastly the residual skin needs excision for cosmetic reasons. The objective of this study is to evaluate management of giant ventral hernia using polypropylene mesh and host tissue barrier after appropriate preoperative preparation. For tension free closure, no attempt at approximation of the muscle to close the defect was done. The mesh was separated from the viscera by a host tissue barrier composed of a small part of the hernia sac and the greater omentum. Patients and Methods This study is a prospective study included 35 patients treated at surgery department Assiut University Hospital in the period from January 2005 and January 2007. Patients booked for elective repair of giant ventral hernia had complete preoperative fitness. All patients gave written informed consent, and the local ethics committee approved the study. The exclusion criteria were as follows: strangulated or obstructed hernia, major co-morbidities as severe cardiac, renal or respiratory disease, and intra-oper- ative musculoaponeurotic defect 10 cm or less in diameter. Two days before surgery, the patients kept on a low residue diet that changed to full liquid diet the day before operation. The patients underwent colonic washing out using Sodium Phosphate enema to deflate the bowel the day before surgery. All procedures were done under general endotracheal anesthesia. At the onset of anesthesia, a cephalosporin was administered intravenously. A nasogastric tube and Foley’s catheter were introduced after induction of anesthesia. An 226 Articles © The authors, Journal compilation © J Clin Med Res and Elmer Press™, www.jocmr.org