181 Lessons Learned from Complex Abdominal Wall Reconstruction for the Management of Giant Paraoesophageal Hernia - a Case Analysis

Abstract Aim In this case report, we present a new method in the management of giant hiatus hernia: use crural relaxing incisions. This combination with previously known strategies including botox and preoperative optimisation for surgery weight loss prehabiliation can result more effective surgical hernia repair subsequently lead to reduced risk recurrence. Case Presentation 71yo man admitted hospital one-week history generalised abdominal pain, nausea, vomiting chest pain. He had background large last 10 years. An CT showed type IV containing stomach, transverse colon, pancreatic body, neck. guided botulinum toxin A injections were given by interventional radiology during which muscle bellies transversus abdominus, internal external obliques targeted. The patient was placed on meal replacement (Optifast) diet. laparoscopic thoraco-abdominal performed finding entire first part duodenum, left lobe liver, small bowel distal pancreas. Due size potential tension likely from repair, both right incisions made facilitate closure. Crural closure reinforced Bio mesh secured C configuration covering incision. recovered well postoperatively. Follow up imaging did now show