Giant incisional hernia: staged repair using pneumoperitoneum and expanded polytetrafluoroethylene.

A very large incisional hernia measuring 59 x 35 cm was repaired in four stages after preoperative creation of a pneumoperitoneum using a Tenckoff catheter to facilitate reduction of the contents of the sac into the peritoneal cavity. Initially, three large sheets of 2-mm-thick expanded polytetrafluoroethylene (ePTFE, GORE-TEX Soft Tissue Patch) were used to bridge the defect. Two subsequent procedures further tightened the abdominal wall by excising several inches of the central part of the patch. During the fourth operation, the remaining ePTFE was explanted and replaced with two 15 x 19 pieces of macroporous ePTFE sheet (GORE-TEX Mycro Mesh), overlapping the lateral edges of healthy fascia to prevent herniation from the sides. Postoperative complications included a small draining sinus that cleared after the final operation and a seroma that resolved in several weeks. The patient has recovered and walks normally, which she was unable to do earlier.