**4. Contraindications for the hybrid technique**

Obese patients (with BMI > 35 kg/m2 ) should be primarily qualified to laparoscopic hernia repair which gives them more benefits than the hybrid technique (e.g., less infection complications, earlier recovery).

Patients with giant incisional hernia with loss of abdominal domain are the most challenging ones and require an individual preoperative treatment. Loss of domain (LOD) occurs when an abdominal wall defect progresses to a size at which it may no longer accommodate the viscera, leading to protrusion outside of the abdominal wall and into the hernia sac [13]. Hernia defect area can be calculated from cross-sectional imaging using computed tomography (CT), and hernia sac volume (HSV) and peritoneal cavity volume (CV) are obtained from preoperative CT measurements. If the calculated volume ratio (VR = HSV/CV) is larger than 25%, loss of domain is observed [14]. In these cases the individual preoperative treatment includes pulmonary training, an installation of a pneumoperitoneum, or an implantation of an expander system to achieve a relaxation and stretching of the skin and muscles as well [15].
