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AWR Challenging Cases 2013 Frederic Eckhauser, M.D. Johns Hopkins Hospital

AWR Challenging Cases 2013 Frederic Eckhauser, M.D. Johns Hopkins Hospital. W.L. is a 40-year-old woman with a significant history of morbid obesity, anxiety, hypertension, obstructive sleep apnea, depression, and a massive abdominal wall hernia with loss of domain.

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AWR Challenging Cases 2013 Frederic Eckhauser, M.D. Johns Hopkins Hospital

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  1. AWR Challenging Cases 2013Frederic Eckhauser, M.D.Johns Hopkins Hospital • W.L. is a 40-year-old woman with a significant history of morbid obesity, anxiety, hypertension, obstructive sleep apnea, depression, and a massive abdominal wall hernia with loss of domain. • Past surgical history includes cesarean section in 1992 with resulting incisional hernia. Attempted repair with the implantation of synthetic mesh in 1996 and 1998 at outside facilities. Additional surgeries included sleeve gastrectomy in January 2011 and laparoscopic cholecystectomy in 1990. The patient was admitted on multiple occasions for small bowel obstruction which resolved with conservative management.

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  4. AWR Challenging Cases 2013 • Operation: • Exploratory laparotomy, removal of previously placed mesh, creation of extensive bilateral abdominal fascial flaps • Small bowl resection and subtotal colectomy with anastomosis between distal ileum and descending colon • Reconstruction of the abdominal wall using a 20 x 30cm 3mm SurgiMend underlay, primary fascial closure, soft polypropylene mesh onlay • Modified semi open VAC negative pressure wound management system used for closure

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  11. AWR Challenging Cases 2013 • Outcome: • Discharged to home on POD 32 in good condition without complication. • Lessons Learned: • Massive abdominal wall reconstruction with loss-of-domain can and should be managed by true multidisciplinary group for support extending beyond the original operation. • Question: • What is the groups approach to the loss-of-domain patient who is morbidly obese?

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