Conservative treatment of abdominal compartment syndrome after large ventral hernia repair
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Surgical repair of large ventral hernias has become feasible after introduction of synthetic meshes and development in intensive-care treatment. In addition to operative challenges, the postoperative disorders incurred as the consequences of increased intra-abdominal pressure (IAP) still expose patients to severe risks.
A 44-year-old man was admitted in our institution for the large ventral hernia repair. Despite large ventral hernia with thickened subcutaneous tissue above hernia sac, a relatively small primary defect that was easy to repair was found on abdominal computed tomography. Intra-operatively, the primary defect was 10 cm in diameter with preserved abdominal front wall layers around it. The hernia sac was resected and ventral hernioplasty was performed with Prolene® mesh. IAP, measured intra-operatively and after extubation of the patient, was normal. On the second postoperative day, the patient was intubated due to respiratory failure in development of abdominal compartment syndrome (ACS). This condition was treated conservatively and he was extubated on the sixth postoperative day. The subsequent course was uneventful and the patient was discharged 14 days after the surgery with significant improvement in his mobility.
Results and conclusions
Relatively small abdominal wall defect of large ventral hernia made surgery less complicated than assumed on the first presentation. The most important determinants of the postoperative complications were the mismatch of the original abdominal cavity and the mass of tissue with loss of domain. Conservative treatment of IAH/ACS should be implemented as early as possible, which can lead to the resolution of ACS as presented in our case.
- Bucknall, TE, Cox, PJ, Ellis, H (1982) Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed) 284: pp. 519-20
- George, CD, Ellis, H (1986) The results of incisional hernia repair: a twelve year review. Ann R Coll Surg Engl. 68: pp. 185-7
- Luijendijk, RW, Hop, WC, Van Den Tol, MP (2000) A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 343: pp. 392-8 CrossRef
- Burger, JW, Luijendijk, RW, Hop, WC (2004) Long term follow up of a randomized controlled trial of suture versus mesh repair of incisonal hernia. Ann Surg 240: pp. 578-83
- Reichenberger, MA, Stoff, A, Richter, DF (2008) Dealing with the mass: a new approach to facilitate panniculectomy in patients with very large abdominal aprons. Obes Surg. 18: pp. 1605-10 CrossRef
- Langer, S, Christiansen, J (1985) Long-term results after incisional hernia repair. Acta Chir Scand. 151: pp. 217-9
- Anthony, T, Bergen, PC, Kim, LT (2000) Factors affecting recurrence following incisional herniorrhaphy. World J Surg. 24: pp. 95-101 CrossRef
- Leber, GE, Garb, JL, Alexander, AJ (1998) Long term complications associated with prosthetic repair of incisional hernias. Arch Surg. 133: pp. 378-82 CrossRef
- Deysine, M (1998) Ventral herniorrhaphy: treatment evolution in a hernia service. Hernia. 2: pp. 15-8 CrossRef
- Shell, DH, Torre, J, Andrades, P, Vasconez, LO (2008) Open repair of ventral incisional hernias. Surg Clin N Am 88: pp. 61-3 CrossRef
- Tanaka, EY, Yoo, JH, Rodrigues, AJ (2010) A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia. 14: pp. 63-9 CrossRef
- Chisholm, J, Dean, NR (2011) Massive paraumbilical hernia: not all is as it seems. Hernia. 15: pp. 333-7 CrossRef
- An, G, West, MA (2008) Abdominal compartment syndrome: a concise clinical review. Crit Care Med. 36: pp. 1304-10 CrossRef
- Milev, B, Mirkovic, D, Bezmarevic, M (2010) Intra-abdominal hypertension and abdominal compartment syndrome. Vojnosanit Pregl 67: pp. 674-80 CrossRef
- Hunter, JD (2008) Abdominal compartment syndrome: an underdiagnosed contributory factor to morbidity and mortality in the critically ill. Postgrad Med J 84: pp. 293-8 CrossRef
- Schachtrupp A, Hoer J, Tons C, et al. Intra-abdominal pressure: a reliable criterion for laparostomy closure? Hernia. 2002;6:102–7.
- English W. Abdominal compartment syndrome. World Federation of Societies of Anaesthesiologists (Internet). 2008. (cited 2008 Nov 30). Available from: http://totw.anaesthesiologists.org/2008/11/30/amdominal-compartment-syndrome-120/.
- Cheatham, ML, Safcsak, K (1998) Intraabdominal pressure: a revised method for measurement. J Am Coll Surg 186: pp. 594-5 CrossRef
- Cassar, K, Munro, A (2002) Surgical treatment of incisional hernia. Br J Surg. 89: pp. 534-45 CrossRef
- Koontz, AR (1958) Hernias that have forfeited the right of domicile: use of pneumoperitoneum as an aid in their operative cure. South Med J. 51: pp. 165-8 CrossRef
- Raynor, RW, Del Guercio, LR (1989) The place for pneumoperitoneum in the repair of massive hernia. World J Surg. 13: pp. 581-5 CrossRef
- Mayagoitia, JC, Suarez, D, Arenas, JC, Diaz de Leon, V (2006) Preoperative progressive pneumoperitoneum in patients with abdominal-wall hernias. Hernia 10: pp. 213-7 CrossRef
- Mathes, SJ, Steinwald, PM, Foster, RD, Hoffman, WY, Anthony, JP (2000) Complex abdominal wall reconstruction: a comparison of flap and mesh closure. Ann Surg. 232: pp. 586-96 CrossRef
- King, JN, Didlake, RH, Gray, RE (1986) Giant inguinal hernia. South Med J. 79: pp. 252-3 CrossRef
- Ammar, SA (2009) Management of giant ventral hernia by polypropylene mash and host tissue barrier: trial of simplification. J Clin Med Res. 1: pp. 226-9
- Ramirez, OM, Ruas, E, Dellon, AL (1990) Component separation method for closure of abdominal wall defects: an anatomic and clinic study. Plast Reconstr Surg. 86: pp. 519-426 CrossRef
- Crovella F, Bartone G, Fei L. Incisional hernia. In: Corso V, Bartolucci E, Todaro M, Veneroni L, Francioni G, editors. Abdominal compartment syndrome: clinical and physiopathologic implications in giant ventral hernias. Milano: Springer; 2008. pp. 47–56.
- Munegato, G, Grigoletto, R, Brandolese, R (2000) Respiratory mechanics in abdominal compartment syndrome and large incisional hernias of the abdominal wall. Hernia. 4: pp. 282-5 CrossRef
- Crovella F, Bartone G, Fei L. Incisional hernia. In: Munegato G, Schiano di Visconte M, Ros DD, Sanna A, editors. Respiratory physiopathology in surgical repair of large abdominal hernias. Milano: Springer; 2008. pp. 57–72.
- Cheatham, ML (2009) Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome. World J Surg 33: pp. 1116-22 CrossRef
- Parra, JA, Revuelta, S, Gallego, T, Bueno, J, Berrio, JI, Farinas, MC (2004) Prosthetic mesh used for inguinal and ventral hernia repair: normal appearance and complications in ultrasound and CT. Br J Radiol. 77: pp. 261-5 CrossRef
- Chang, EI, Foster, RD, Hansen, SL, Jazayeri, L, Patti, M (2007) Autologous tissue reconstruction of ventral hernias in morbidly obese patients. Arch Surg. 142: pp. 746-51 CrossRef
- Bingener, J, Buck, L, Richards, M, Michalek, J, Schwesinger, W, Sirinek, K (2007) Long-term outcomes in laparoscopic vs open ventral hernia repair. Arch Surg. 142: pp. 562-7 CrossRef
- Novitsky, Y, Cobb, W, Kercher, K, Matthews, B, Sing, R, Heniford, T (2006) Laparoscopic ventral hernia repair in obese patient. Arch Surg. 141: pp. 57-61 CrossRef
- Flancbaum, L, Choban, PS (1998) Surgical implications of obesity. Annu Rev Med. 49: pp. 215-34 CrossRef
- Lambert, DM, Marceau, S, Forse, RA (2005) Intra-abdominal pressure in the morbidly obese. Obes Surg. 15: pp. 1225-32 CrossRef
- Leppaniemi, A (2009) Surgical management of abdominal compartment syndrome; indications and techniques. Scand J Trauma Resusc Emerg Med. 17: pp. 17 CrossRef
- Conservative treatment of abdominal compartment syndrome after large ventral hernia repair
Volume 45, Issue 1 , pp 31-36
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- Springer Vienna
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- Large, ventral, hernia
- Abdominal, compartment, syndrome
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- Author Affiliations
- 1. Clinic for General Surgery, Military Medical Academy, Crnotravska 17, 11000, Belgrade, Serbia
- 2. Clinic for Plastic and Reconstructive Surgery, Military Medical Academy, Belgrade, Serbia