Case 196


A 54-year-old female patient, diabetic, BMI of 59.6 kg/m², subjected to bariatric surgery under Fobi-Capella technique by xifoumbilical laparotomy. It evolved with incisional hernia after 4 months (her BMI was 45.4 kg/m²), and it was opted to wait for more weight loss before intervention. After three years, there was stabilization of weight (BMI 37.8 kg/m²), but with greater volume hernia. Requested abdominal computed tomography (CT) to pre-surgical planning (see below).

Abdominal CT, axial cut at the level of the L1 vertebra, without contrast.


Abdominal CT scan, non-contrast axial (at the level of T12 vertebra) and sagittal cuts, respectively. It shows maximum dimensions at each axis defect in the abdominal wall: transverse axis: 12,1cm; longitudinal: 12,3cm.


Three-dimensional reconstruction of images obtained by abdominal CT, since T8 vertebra to the root of the thighs.


Abdominal CT: Analysis of abdominal cavity dimensions (upper cuts) and the hernia sac (lower cuts). Dimensions of abdominal cavity: anteroposterior: 18.4cm; longitudinal: 31,3cm; transverse: 22.9cm. Dimensions of hernia sac: anteroposterior: 9,9cm; longitudinal: 26,7cm; transverse: 27,7cm.

Given the clinical presentation and CT images attached, which would be the most appropriate approach?

Leave a Reply