Patient's journey with a hernia.

INTRODUCTION: Complex hernia repair presents a significant challenge for abdominal wall surgeons. These large hernias are often associated with substantial parietal retraction, making simple fascial closure techniques insufficient. Chronic muscle contracture and retraction can reduce the volume of the peritoneal cavity, complicating closure and increasing the risk of abdominal compartment syndrome, ventilatory compromise, and hernia recurrence. Adequate preoperative optimization of patients with large ventral hernias is essential to minimize serious postoperative complications and improve surgical outcomes. This paper presents two case reports of complex abdominal wall reconstruction (AWR), highlighting the role of prehabilitation, modern fascial closure techniques, and, in one case, the management of a complicated postoperative course. CASE REPORTS: Two patient cases are described in detail, including their prehabilitation strategies, surgical approaches, postoperative courses, and final outcomes. CONCLUSION: These case reports demonstrate the importance of thorough prehabilitation, careful surgical planning, and comprehensive postoperative care in patients with complex incisional hernias. The authors discuss current trends in hernia surgery and provide insight into contemporary approaches to AWR.