Effective Management of Giant Ventral Hernias: A Comprehensive Approach Combining Preoperative Botulinum Toxin Application, Modified Ramírez's Component Separation, and Rives-Stoppa Hernioplasty.

Introduction  Giant ventral hernias are a surgical challenge due to their size and the need for a specialized approach during repair. Over the decades, abdominal wall surgery has evolved into a sophisticated field with a wide range of techniques aimed at improving patient outcomes. However, there is no universally accepted method suitable for repairing all giant ventral hernias. Surgeons must rely on a combination of techniques, choosing the approach that best matches their expertise, available resources, and the individual patient's specific needs. This article explores the effective use of a combination of techniques, including preoperative botulinum toxin application, modified Ramírez's component separation, and Rives-Stoppa hernioplasty, yielding excellent results and minimizing recurrences. Objective  This study aims to provide a comprehensive literature review of giant ventral hernias. Additionally, we aim to share our experience in managing and repairing giant ventral hernias using a multi-modal approach, combining various surgical techniques with a focus on patient safety, reduced recurrence rates, and improved quality of life. Methods Between October 1, 2019, and October 1, 2021, six patients with giant ventral hernias were enrolled at our department of surgery. They received preoperative botulinum toxin A (BT) application, underwent corrective surgery involving modified component separation following the Ramírez method, and received Rives-Stoppa hernioplasty. Follow-up was conducted for at least six months. Results Six patients were included in the study: three women and three men. They had an average age of 53.6 years and an average body mass index of 31.8 kg/m. The most common location of the hernia defect was supra and infraumbilical, among 66% of cases. The primary adverse effect associated with BT application was abdominal distension, reported in 33% of patients. No postoperative complications, such as abscesses or seromas, were observed. After the surgical procedure, the average hospital stay was 2.6 days, and no recurrences were noted within six months post-surgery. Conclusion  The proposed method, which involves a combination of techniques, has demonstrated promising results based on our experience. However, to solidify these findings and better understand the full scope of this approach, further comprehensive statistical studies involving larger populations are essential. These studies will not only validate our results but also provide valuable insights for optimizing the management of giant ventral hernias.