Treatment of ventral hernias with "loss of domain" is a surgical challenge, and in this review, an overview of the current literature is presented. Abdominal compliance can be increased intra-operatively by performing component separation and/or organ reduction but leads to increased post-operative morbidity. As a result, preoperative methods, which increase abdominal compliance, are of interest: tissue expanders, progressive pneumoperitoneum, and botulinum toxin A. The aim of them all is to expand the abdominal wall allowing reconstruction while reducing complications.
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