We see some incredible hernias in Nigeria-inguinal as well as ventral. Many of these have been present for decades! Sometimes the intestines bulge out of these patients so long that they do not want to go back into the abdomen. The term loss of domain refers to the clinical situation where the viscera live in the hernia rather than in the abdominal cavity. This lady is a typical example. We were able to repair her hernia using mesh.
Loss of domain
Repair of these hernias can be difficult, sometimes almost impossible, without mesh. Unfortunately, mesh is expensive-way beyond the means of our typical patient. Fortunately, companies such as Ethicon, Atrium, and Covidien have been very generous in donating their product. 
Repair with mesh

Many of the Nigerian surgical residents and surgeons who come to work with me in Nigeria have never used mesh. It is very exciting for them to learn mesh repair and bring this knowledge back to their medical centers.
Dr. Ifeanyi with donated mesh