Background

This video highlights the pre and intraoperative management of an acutely incarcerated ventral hernia in a morbidly obese patient after weight loss from his staged bariatric surgery. Patient is a 39 year old male with a BMI of 70 who presents with a fat containing ventral hernia, and a decision was made to perform staged bariatric surgery prior to elective hernia repair. Patient had excellent results from bariatric surgery but was readmitted prior to his planned elective repair with a massive incarcerated hernia causing small bowel obstruction. Given the emergent nature of his presentation, our initial plan was to perform an open ventral hernia repair. Upon further consideration of the patient's body habitus and extensive comorbidities, we were concerned about closing the patient's abdomen without tension and a prolonged hospital course complicated by wound breakdown and dehiscence, so attempted a laparoscopic approach. After gentle manipulation of the incarcerated bowel and momentum without success, we used the ultrasonic device to open the fascia and widen the defect. We alternated between using the ultrasonic device and gentle traction on the small bowel, eventually enabling us to reduce the entirety of the hernia contents. We chose to perform a primary repair in light of the patient's ongoing weight loss after sleeve gastrectomy, with plan for definitive hernia repair in the future.