[Visceral reduction in surgical treatment of 'impossibly' large abdominal hernias]

The authors present a group of 6 patients treated in 1996-2000 with giant "impossible" hernia the contents of which "lost their rights in the abdominal cavity". The patients involved were old polymorbid people (mean age 75 years), 5 suffered from acute, one from chronic obstruction of the gut. After intensive preparation the authors implemented a hernioplasty, using an excessive surgical mesh, reduced the volume of the abdominal contents by the omentum in all subjects, by the right colon in two and by a 0.5-1 m segment of the ileum in 3 patients. Only one extremely polymorbid patient died because of multiorgan failure on the 17th day after surgery. In 5 patients artificial ventilation was necessary from 2 hours to 17 days. As to complications, diarrhoea was recorded in one patient and infection of the mesh in another one. The authors conclude that the majority of "impossible" incarcerated hernias can be resolved by visceroreduction and enlargement of the volume of the abdominal cavity by inserting an excessive surgical mesh into the enlarged hernial neck. In elective operations of such hernias for the preparation forced reduction of the weight can be used and the technique of enlargement of the abdominal volume by intermittent pneumoperitoneum. In this way a giant "impossible" hernia can be treated without threatening the patient's life by cardiopulmonary failure.