Patient-engaged preoperative optimization for a complex incisional hernia: a case report.

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.