Massive paraumbilical hernia: not all is as it seems

We discuss the management of an otherwise healthy obese patient who presented with a massive paraumbilical hernia extending into a large lymphoedematous abdominal apron. After anaesthetic assessment and abdominal computed tomography (CT), the patient underwent an elective operation. The hernia was dissected free of the heavy lymphoedematous apron with the aid of orthopaedic pins and a motorised patient lifter. Despite the size of the hernia, the primary defect was found to be relatively small and easy to reduce. The defect was repaired with a sublay Proceed® mesh and skin closure was achieved primarily. The patient had an uneventful post-operative course and gained significant improvement in her mobility.