The North Port man's abdominal hernia started after an ill-timed, post-cancer-surgery sneeze. A major heart attack added to the series of health blows that allowed the hernia to balloon far beyond normal.

Unable to work and uninsured, Fico despaired of finding help.

But last month, vascular surgeon Jonathan Yunis finally relieved Fico, 62, of his dangerous burden in a two-hour hernia repair at Sarasota Memorial Hospital.

There appears to be no record book for hernia size. But Yunis, who specializes in hernias and performs some 500 surgeries on them each year, said that even on medical missions to undeveloped parts of the world, he has not encountered a case like Fico's.

"In Africa, the Dominican Republic and Haiti, I have never seen anything quite this big," Yunis said.

The complex operation required moving Fico's intestines back into his body and closing the abdominal wall with a state-of-the-art mesh made from animals' skin. Yunis said Fico is "out of the woods," and he is recovering at home.

"It feels like I made it through a war," Fico said, "and I'm still overseas."

But the hardest part may have been losing about 100 pounds so he could undergo surgery in the first place; it proved such a challenge that there were times Fico despaired.

"When you have something like this, you start to shut down; you start to shut the world out," Fico said just before his Jan. 9 operation, reclining in bed with one arm resting atop what looked like a slightly off-center pregnancy. "Plus, I'm Italian. When things go wrong, you sit down and eat."

One thing and another

Fico's string of problems seemed unending. It began with a cancerous tumor in his kidney, discovered during a routine physical. Part of the organ was removed, and he was cancer-free.

But walking through the hospital the next day, Fico recalled, "I sneezed twice, and I heard it pop."

A ventral hernia occurs when organs escape through a weakness in the muscle tissues around the abdomen. In the beginning, the bulge was about the size of a softball, but because he had just undergone the kidney procedure, he was told to wait six months for a hernia repair.

"Then I had open-heart surgery," he said, "and they said they couldn't touch me for three years."

At first, Fico focused on recovering from his heart attack. But as the hernia grew, he became depressed and lost his job. He spent more time on the couch and turning to food for solace.

"He ate himself into oblivion," said his sister, Pam Fico, who helped him qualify for disability and Medicare — a two-year process. "When he hit 355, it was scary."

The fatter Fico became, the larger the hole in his belly grew, allowing more of his organs to slip out. Doctors declared the hernia inoperable, and it threatened to cut off the blood supply to his intestines.

"I went from doctor to doctor," Fico said. "When they saw this, nobody wanted to do anything about it." His lack of insurance coverage was a factor, and so was the high potential for surgical failure and complications.

Fico's daily life changed dramatically. He liked to work on cars, but the hernia's mass made leaning over an engine impossible. It took him all day, he said, just to clean his small house.

"You're constantly walking forward," Fico said, describing the estimated 25-pound weight hanging in front of him. It took him an hour each day to put on two elastic wraps to support the burden, and they cut into his skin painfully.

Fico said his faith, and his music ministry at Port Charlotte International Church, sustained him.

Then, on a dating website called ChristianMingle.com, he found something unexpected — a fiancee. "She met me at the height of this," Fico said. "I had this photo where I looked really good. I was wearing a black tank top, with my arms crossed on top, so you couldn't see the hernia."

Peg d'Arpino said she had only signed up on the site for a short time and was not expecting much. Then she saw Fico's picture, and noticed his dimples.

After he warned her about his medical problem, she recalled, "I said, 'That's not you. I only care about what's inside.'"

Then Fico had another encounter that would change his life — one he also attributes to divine intervention. He said he found Yunis in the phone book. When he met the surgeon, "His first words were, 'Wow, that's a large hernia,'" Fico said.

Yunis told him repairing the damage would not be easy, nor would losing nearly a third of his weight.

"Then he said, 'I'm going to work with you, Jim,'" Fico remembered. "The feeling I had, it was like going over a roller coaster for the first time, when you're at the very top."

Shedding the weight

Hernias like Fico's are not so much removed as rearranged. The delicate aspect is making sure blood supply to the organs remains intact.

"I was able to fit everything everything back inside and then create a new abdominal wall," Yunis explained. "There was still a lot of pressure on all the stuff I put back in, so I needed to reinforce it with a mesh."

The synthetic mesh generally used for hernia repairs is made of plastics, and carries a risk of infection, Yunis said. Instead, he used an expensive biological mesh, made of pigskins and cow hides treated to strip away the cellular material and leave pure collagen.

"We sew this thing literally underneath the repair," Yunis said. "The patient's tissue starts to migrate and revitalize this dead hide. There is a good chance he will never have a hernia again, because this material is so accepting of human blood circulation."

Fico's pre-operative weight loss, Yunis said, represents the real breakthrough in giant hernia repair. Yunis said that about six years ago, he had a "change in philosophy" that led him to insist on major weight loss for patients with large hernias. He plans to present his most dramatic case at surgical conferences to prove his point.

Without the weight loss, pressure would pop the hernia open, push the diaphragm into the chest, possibly forcing the patient to live on a ventilator, or cause kidney failure, Yunis said.

Fico said one of the biggest problems in his two-year struggle to shed pounds was that the hernia kept him from feeling full. It was as if everything he ate escaped through that rupture in his abdominal wall.

"You'd go out to dinner with friends and eat an entire meal," Fico said, "and by the time you got home you had hunger pains."

Praying helped, he said. So did Pam and Peg, who made soup and prodded him to eat more vegetables. Melanie Wilber, Yunis' nurse, acted as his personal weight coach through the process, even calling him from home shortly after her daughter was born.

"Mr. Fico was pretty much sitting at idle with his weight, so we spent lots of time on the phone," Wilber said. "I would say, 'Just think: You are going to be a new man.'"

Weight loss this profound depends not on fad diets, but on taking in fewer calories, she emphasized.

"The interesting thing is that just by explaining this concept of why the patient needs to lose the weight, and why they have such trouble, Melanie and I have been able to help them," Yunis said. "Every week, I have people who have lost anywhere from 20 to 100 pounds. They don't cheat because they want this over with."

Recovering at home, Fico said he already feels the difference in the way his body responds to food. And he vowed to keep his weight down so the hernia does not come back.

"When you put food in front of me, it's always been a love affair," he said. "But now I don't feel as hungry as I used to. I've decided to use how I feel as my guide, and I'm watching every single thing that I eat."