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Background <p>Complex ventral hernias with loss of domain (LOD) in pediatric patients represent a rare and formidable surgical problem. Limited availability of autologous tissue and the risk of recurrence necessitate innovative and multidisciplinary strategies.</p> Case Presentation <p>We describe a six-year-old boy with a history of neonatal skin-only closure for gastroschisis who presented with a giant ventral hernia (EHS classification: M1–M5, W3, R1). Preoperative assessment revealed a Tanaka index of 32% and significant rectus diastasis. The patient underwent a staged reconstructive protocol: preoperative botulinum toxin A infiltration, progressive pneumoperitoneum, followed by definitive surgical repair. This included a posterior component separation with unilateral transversus abdominis release (TAR), reinforcement of the posterior fascial layer with an 8 × 7&#xa0;cm cryopreserved fascia lata allograft, and augmentation with a retromuscular bioresorbable mesh. Plastic surgery finalized the reconstruction with dermolipectomy and neoumbilicoplasty. The postoperative recovery was uneventful.</p> Conclusion <p>At 12-month follow-up, the patient is clinically well with no evidence of recurrence, suggesting promising early durability. This case demonstrates that a staged, physiology-based algorithm incorporating fascia lata allograft is a feasible and technically successful strategy for massive pediatric LOD hernias.</p>

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Reconstruction of Complex Ventral Hernia in a Pediatric Patient Using Allogeneic Fascia lata: A case Report and Technical Perspective

  • 期刊论文

  • 发表日期：

    2026年2月27日

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  • David Alejandro Mejía Toro,
  • Luis Francisco Pérez Montaguth,
  • Walter Romero Espitia,
  • Mateo Londoño Barrientos

摘要

Background

Complex ventral hernias with loss of domain (LOD) in pediatric patients represent a rare and formidable surgical problem. Limited availability of autologous tissue and the risk of recurrence necessitate innovative and multidisciplinary strategies.

Case Presentation

We describe a six-year-old boy with a history of neonatal skin-only closure for gastroschisis who presented with a giant ventral hernia (EHS classification: M1–M5, W3, R1). Preoperative assessment revealed a Tanaka index of 32% and significant rectus diastasis. The patient underwent a staged reconstructive protocol: preoperative botulinum toxin A infiltration, progressive pneumoperitoneum, followed by definitive surgical repair. This included a posterior component separation with unilateral transversus abdominis release (TAR), reinforcement of the posterior fascial layer with an 8 × 7 cm cryopreserved fascia lata allograft, and augmentation with a retromuscular bioresorbable mesh. Plastic surgery finalized the reconstruction with dermolipectomy and neoumbilicoplasty. The postoperative recovery was uneventful.

Conclusion

At 12-month follow-up, the patient is clinically well with no evidence of recurrence, suggesting promising early durability. This case demonstrates that a staged, physiology-based algorithm incorporating fascia lata allograft is a feasible and technically successful strategy for massive pediatric LOD hernias.