Ventral Hernia Repair with Loss of Domain Using the Rives-Stoppa Technique: Clinical Case and Review of the Retromuscular Approach

Giant ventral hernias with loss of domain represent a significant surgical challenge due to the difficulty in reintegrating herniated contents into the abdominal cavity without causing increased intra-abdominal pressure and its associated complications. We present the case of a 68-year-old female patient with a giant ventral hernia and loss of domain, successfully repaired using the retromuscular Rives-Stoppa technique. Preoperative preparation included respiratory physiotherapy, progressive pneumoperitoneum, and botulinum toxin injections to optimize abdominal wall compliance and pulmonary function. The surgical approach consisted of careful dissection of the hernia sac, reduction of the herniated contents, wide creation of the retromuscular space, tension-free fascial closure, and placement of a polypropylene mesh with adequate overlap. Postoperative recovery was favorable, with no respiratory or infectious complications and satisfactory functional recovery. This case highlights the importance of a multidisciplinary approach and advanced surgical techniques in managing complex hernias with loss of domain, improving clinical outcomes and patient quality of life.