Case Report: Abdominal Wall Reconstruction in a High-Risk Patient With Incisional Hernia and Complications From Oncological Treatment.

Autor:	Silva TS; Real Hospital Português, Recife, Brazil.; European Hernia Society (EHS), Gdansk, Poland., Martins MR; Real Hospital Português, Recife, Brazil., Batista TL; Real Hospital Português, Recife, Brazil., Martins ED; Real Hospital Português, Recife, Brazil.; Colégio Brasileiro de Cirurgiões, Rio de Janeiro, Brazil., Fernandes MH; Real Hospital Português, Recife, Brazil., Hinrichsen EA; Real Hospital Português, Recife, Brazil.
Jazyk:	angličtina
Zdroj:	Journal of abdominal wall surgery : JAWS [J Abdom Wall Surg] 2023 Sep 11; Vol. 2, pp. 11767. Date of Electronic Publication: 2023 Sep 11 (Print Publication: 2023).
DOI:	10.3389/jaws.2023.11767
Abstrakt:	Introduction: A high risk patient with evisceration underwent to abdominal wall reconstruction without mesh or drains. We present a case of a 62 years-old female patient with a significant medical history of Wilson's disease-related hepatopathy Child-Pugh class B classification, sequelae of a stroke, and relevant surgical background including total hysterectomy, oophorectomy, and Hartmann's procedure for ovarian neoplasm stage 3. The patient developed a large incisional hernia in the midline incision while undergoing Bevacizumab (Avastin) treatment for clinical oncology. During an attempt at skin closure due to erosion and necrosis, there was progressive deterioration leading to evisceration. We opted for abdominal wall reconstruction by transposing the hernia sac without using mesh and employing hemostatic powder (Arista) to mitigate the risk of bleeding in a high-risk patient due to recent bevacizumab use and hepatopathy. The patient had a favorable postoperative course without any other intervention in abdominal wall. Patient developed worsening hepatic function with the presence of ascites, constipation, and disorientation. On the 6th day postoperative, a tomography was performed, which showed colonic distension without obstructive factors and a slight amount of supra-aponeurotic fluid. The patient was discharged on the 10th day postoperative after improvement of the condition with clinical treatment. The patient has been progressing under outpatient follow-up for 5 months, with a resumption of chemotherapy cycles and no evidence of hernia recurrence. Conclusion: Further studies and long-term follow-up are necessary to evaluate the efficacy and safety of hernia sac transposition as a mesh-free technique and the use of hemostatic powder without drains in high-risk patients. However, our case highlights the potential feasibility of these approaches in carefully selected cases. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2023 Silva, Martins, Batista, Martins, Fernandes and Hinrichsen.)
Databáze:	MEDLINE
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