Perioperative management of a patient with bilateral inguinal hernia and loss of “domain”

Giant inguinal hernia is a rare disease in developed countries that results from a patient's refusal to undergo surgery for a long time. Treatment of giant inguinal hernias, especially incurable ones, is a difficult task due to high risk of complications. The most formidable one is abdominal compartment syndrome. Appropriate preoperative management is essential to prevent abdominal compartment syndrome in patients with giant inguinal hernias. We present the effectiveness of preoperative preparation and stage-by-stage surgical treatment of a patient with bilateral giant inguinal-scrotal hernia and 26.3% loss of "domain". The patient underwent preoperative preparation aimed at adapting to hypoxia. Hernia repair with preperitoneal anterior abdominal wall replacement was performed according to original technique (RF patent for invention No. 2307601 dated 10.10.2007) in two stages. Two-stage preperitoneal anterior abdominal wall replacement combined with preoperative aerobic exercise for a giant bilateral inguinal hernia demonstrated effectiveness in adapting the patient to artificially induced hypoxia, preventing abdominal compartment syndrome and reducing the incidence of postoperative complications.