Managing complex abdominal wall defects in the setting of loss of abdominal domain are particularly challenging cases. Single staged repairs can result in abdominal compartment syndrome, respiratory embarassment and cardiovascular collapse. In this video we demonstrate the technique of preoperative pneumoperitoneum and the utilization of endoscopic component separation in reconstructing a massive abdominal wall defect.

Our patient is a 46 year old insulin dependent diabetic who is status post a living related kidney transplant and a failed orthotopic pancreas transplant. He remains on immunsuppression. He has developed a large symptomatic incisional hernia with loss of domain.

This video demonstrates the techniques of preoperative pneumoperitoneum and endoscopic component separation in the management of complex abdominal wall reconstructions.

This video demonstrates a technique of progressive preoperative pneumoperitoneum and endoscopic component separation in treating patients with massive hernias and loss of abdominal wall domain. In selected patients this technique offers excellent results.