A novel surgical solution to impossible fascial closure due to contaminated abdominal cavities: A case report

Chronic, large, and old incisional hernias often lead to surgical complications and major hindrances during emergent laparotomies. The most challenging stages of the laparotomy in such cases occur during opening and fascial closure. This article explains the novel surgical technique employed for the complex abdominal closure upon concluding an emergent laparotomy on a 68-year-old female patient. This innovative technique is appropriate for patients with contaminated abdominal cavities and scant fascia who require abdominal operations in cases where biological mesh is not available or is not a viable option. This surgical technique can help surgeons restrict abdominal contents and organs (particularly the bowel loops) and prevent migration out of the abdominal cavity during the early post-operative stages, hence, reducing post-surgical complications. The discussed surgical technique ensures that the abdominal fascia defect is limited using skin flaps. This defect later develops into a small hernia sac within a few weeks. Patients then need to have a secondary delayed elective operation on this significantly smaller sized hernia for repair using synthetic mesh. •In repairing large hernias, if there is no contamination, the best method is to repair with mesh.•In the presence of contamination and small hernia, initial repair seems reasonable.•If there is a large hernia, the use of biological mesh is a good option if possible.•In our country, due to the existence of sanctions in such circumstances, using the proposed method can be a good alternative.