{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T11:10:21Z","timestamp":1788952221624,"version":"build-2803163510"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Complex hernias with loss of domain present significant surgical challenges. Preoperative strategies such as botulinum toxin A (BTA) injections and progressive preoperative pneumoperitoneum (PPP) combined with structured prehabilitation and active patient participation may facilitate abdominal wall reconstruction. We report the case of a 65-year-old female with a complex incisional hernia. The patient underwent preoperative BTA injections followed by PPP before elective repair. This case highlights the value of a multimodal, patient-centered optimization pathway in facilitating successful abdominal wall reconstruction.<\/jats:p>","DOI":"10.3389\/fsurg.2026.1871565","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:17:03Z","timestamp":1788949023000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient-engaged preoperative optimization for a complex incisional hernia: a case report"],"prefix":"10.3389","volume":"13","author":[{"given":"Styliani","family":"Laskou","sequence":"first","affiliation":[{"name":"3rd Surgical Department, AHEPA University Hospital, Aristotle University of Thessaloniki","place":["Thessaloniki, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodora","family":"Gkeka","sequence":"additional","affiliation":[{"name":"3rd Surgical Department, AHEPA University Hospital, Aristotle University of Thessaloniki","place":["Thessaloniki, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Panayiota","family":"Roulia","sequence":"additional","affiliation":[{"name":"3rd Surgical Department, AHEPA University Hospital, Aristotle University of Thessaloniki","place":["Thessaloniki, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanasios","family":"Astreinidis","sequence":"additional","affiliation":[{"name":"Department of Radiology, AHEPA General University Hospital, Aristotle University of Thessaloniki","place":["Thessaloniki, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leondias","family":"Kougias","sequence":"additional","affiliation":[{"name":"Department of Radiology, AHEPA General University Hospital, Aristotle University of Thessaloniki","place":["Thessaloniki, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George","family":"Geropoulos","sequence":"additional","affiliation":[{"name":"3rd Surgical Department, AHEPA University Hospital, Aristotle University of Thessaloniki","place":["Thessaloniki, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyriakos","family":"Psarras","sequence":"additional","affiliation":[{"name":"3rd Surgical Department, AHEPA University Hospital, Aristotle University of Thessaloniki","place":["Thessaloniki, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Konstantinos","family":"Sapalidis","sequence":"additional","affiliation":[{"name":"3rd Surgical Department, AHEPA University Hospital, Aristotle University of Thessaloniki","place":["Thessaloniki, Greece"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"478","DOI":"10.1016\/j.jamcollsurg.2015.04.026","article-title":"Adverse events after ventral hernia repair: the vicious cycle of complications","volume":"221","author":"Holihan","year":"2015","journal-title":"J Am Coll Surg"},{"key":"B2","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1007\/s00423-023-02811-w","article-title":"State-of-the-art abdominal wall reconstruction and closure","volume":"408","author":"Ayuso","year":"2023","journal-title":"Langenbecks Arch Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2553","DOI":"10.1007\/s00268-009-0203-3","article-title":"Use of botulinum toxin type a before abdominal wall hernia reconstruction","volume":"33","author":"Ibarra-Hurtado","year":"2009","journal-title":"World J Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1413","DOI":"10.1007\/s10029-021-02499-1","article-title":"A systematic review and meta-analysis of technical aspects and clinical outcomes of botulinum toxin prior to abdominal wall reconstruction","volume":"25","author":"Timmer","year":"2021","journal-title":"Hernia"},{"key":"B5","doi-asserted-by":"publisher","first-page":"11230","DOI":"10.3389\/jaws.2023.11230","article-title":"Preoperative progressive pneumoperitoneum in the treatment of hernias with loss of domain. 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