Staged weight loss enabled successful repair of complex recurrent hernia at CK Birla Hospitals, CMRI

A 47 year old woman lost 27 kg following bariatric surgery before undergoing advanced abdominal wall reconstruction for a recurrent ventral hernia.

A multidisciplinary team at CK Birla Hospitals, CMRI, successfully treated a 47 year old woman with a complex recurrent ventral hernia after adopting a staged surgical approach that began with significant weight loss.
The patient, from Kolkata, had undergone ventral hernia repair in 2014, but the condition recurred within a year. Over the following nine years, the hernia progressively enlarged. When she arrived at CK Birla Hospitals, CMRI, she had a body mass index of 49 along with type 2 diabetes, hypertension and hypothyroidism.

According to the treating team, the patient had developed a condition known as loss of domain, where a significant portion of the abdominal contents remains outside the abdominal cavity. Such cases carry an increased risk of complications, including wound breakdown, infection, recurrence and respiratory problems if surgery is attempted without adequate preparation.
Instead of proceeding directly with hernia repair, the surgical team first performed a laparoscopic sleeve gastrectomy to reduce the patient’s weight and improve her overall metabolic health.
Over the next seven months, the patient lost approximately 27 kg, while her diabetes became better controlled. The weight loss also reduced the complexity of the planned abdominal wall reconstruction.

Commenting on the case, Dr. Sarfaraz J. Baig, Senior Consultant, GI Surgery, CK Birla Hospitals, CMRI, said, “This case demonstrates why staged planning matters in complex hernia surgery. A hernia of this size and complexity, in a patient with this degree of obesity and metabolic burden, carries a very high risk of failure and serious complications if addressed immediately. The 27 kg of weight loss the patient achieved before surgery fundamentally changed what was possible. It reduced the technical difficulty of the repair, improved her metabolic resilience, and gave us the conditions to achieve an outcome that would have been considerably harder to sustain without that preparation.”
Following the weight loss, Dr. Baig performed a Transversus Abdominis Release with Peritoneal Flap Repair, commonly known as TAR Plus, along with a vertical panniculectomy to remove excess abdominal tissue.

The procedure involved reconstructing the abdominal wall using the patient’s preserved hernia sac and reinforcing the repair with a large surgical mesh placed behind the abdominal muscles. The additional panniculectomy improved surgical access while contributing to the overall functional outcome.
According to the hospital, the patient recovered without major postoperative complications and achieved restoration of the abdominal wall following the staged treatment plan.

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