GIANT INCISIONAL HERNIA WITH LOSS OF DOMAIN, TREATED SUCCESSFULLY WITH PRIMARY HERNIA REPAIR, SLEEVE GASTRECTOMY, OMENTECTOMY AND SUBTOTAL COLECTOMY

Giant incisional hernia is a challenging surgical condition, especially in morbidly obese patients, and requires individualized surgical planning and technique. A 54-year-old female with body mass index of 54 kg/m2 with insulin-dependent diabetes mellitus presented with an extremely large incisional ventral hernia at the site of right subcostal incision from a remote open cholecystectomy. The hernia contained distended stomach, omentum, most of the small bowel, transverse and right colon, and right kidney. After medical optimization, patient underwent sleeve gastrectomy, subtotal colectomy, and primary repair of the hernia. After 10 months, there was no hernia recurrence, the patient?s BMI decreased to 37.8 kg/m2, and she no longer required insulin or oral hypoglycemic medications. In conclusion, concomitant sleeve gastrectomy can be considered with repair of giant incisional hernia in patients with morbid obesity, and colectomy can be considered in cases with loss of domain and long patulous colon.