Skip to main content
SpringerLink
Log in

Conservative treatment of abdominal compartment syndrome after large ventral hernia repair

  • Case Report
  • Published:
European Surgery Aims and scope Submit manuscript

Summary

Background

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.

Case report

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Bucknall TE, Cox PJ, Ellis H. Burst abdomen and incisional hernia: a prospective study of 1129 major laparotomies. Br Med J (Clin Res Ed). 1982;284(6364):519–20.

    Google Scholar 

  2. George CD, Ellis H. The results of incisional hernia repair: a twelve year review. Ann R Coll Surg Engl. 1986;68(4):185–7.

    PubMed  CAS  Google Scholar 

  3. Luijendijk RW, Hop WC, Van Den Tol MP, et al. A comparison of suture repair with mesh repair for incisional hernia. N Engl J Med. 2000;343(6):392–8.

    Article  PubMed  CAS  Google Scholar 

  4. Burger JW, Luijendijk RW, Hop WC, et al. Long term follow up of a randomized controlled trial of suture versus mesh repair of incisonal hernia. Ann Surg. 2004;240(4):578–83. (discussion:583–5).

    PubMed  Google Scholar 

  5. Reichenberger MA, Stoff A, Richter DF. Dealing with the mass: a new approach to facilitate panniculectomy in patients with very large abdominal aprons. Obes Surg. 2008;18:1605–10.

    Article  PubMed  Google Scholar 

  6. Langer S, Christiansen J. Long-term results after incisional hernia repair. Acta Chir Scand. 1985;151:217–9.

    PubMed  CAS  Google Scholar 

  7. Anthony T, Bergen PC, Kim LT. Factors affecting recurrence following incisional herniorrhaphy. World J Surg. 2000;24(1):95–101.

    Article  PubMed  CAS  Google Scholar 

  8. Leber GE, Garb JL, Alexander AJ, et al. Long term complications associated with prosthetic repair of incisional hernias. Arch Surg. 1998;133(4):378–82.

    Article  PubMed  CAS  Google Scholar 

  9. Deysine M. Ventral herniorrhaphy: treatment evolution in a hernia service. Hernia. 1998;2:15–8.

    Article  Google Scholar 

  10. Shell DH, Torre J, Andrades P, Vasconez LO. Open repair of ventral incisional hernias. Surg Clin N Am. 2008;88:61–3.

    Article  PubMed  Google Scholar 

  11. Tanaka EY, Yoo JH, Rodrigues AJ, et al. A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia. 2010;14:63–9.

    Article  PubMed  CAS  Google Scholar 

  12. Chisholm J, Dean NR. Massive paraumbilical hernia: not all is as it seems. Hernia. 2011;15:333–7. doi:1007/s10029–010-0645-4.

    Article  PubMed  CAS  Google Scholar 

  13. An G, West MA. Abdominal compartment syndrome: a concise clinical review. Crit Care Med. 2008;36:1304–10.

    Article  PubMed  Google Scholar 

  14. Milev B, Mirkovic D, Bezmarevic M, et al. Intra-abdominal hypertension and abdominal compartment syndrome. Vojnosanit Pregl. 2010;67(8):674–80.

    Article  PubMed  Google Scholar 

  15. Hunter JD. Abdominal compartment syndrome: an underdiagnosed contributory factor to morbidity and mortality in the critically ill. Postgrad Med J. 2008;84:293–8.

    Article  PubMed  CAS  Google Scholar 

  16. Schachtrupp A, Hoer J, Tons C, et al. Intra-abdominal pressure: a reliable criterion for laparostomy closure? Hernia. 2002;6:102–7.

  17. 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/.

  18. Cheatham ML, Safcsak K. Intraabdominal pressure: a revised method for measurement. J Am Coll Surg. 1998;186:594–5.

    Article  PubMed  CAS  Google Scholar 

  19. Cassar K, Munro A. Surgical treatment of incisional hernia. Br J Surg. 2002;89:534–45.

    Article  PubMed  CAS  Google Scholar 

  20. Koontz AR. Hernias that have forfeited the right of domicile: use of pneumoperitoneum as an aid in their operative cure. South Med J. 1958;51:165–8.

    Article  PubMed  CAS  Google Scholar 

  21. Raynor RW, Del Guercio LR. The place for pneumoperitoneum in the repair of massive hernia. World J Surg. 1989;13(5):581–5.

    Article  PubMed  CAS  Google Scholar 

  22. Mayagoitia JC, Suarez D, Arenas JC, Diaz de Leon V. Preoperative progressive pneumoperitoneum in patients with abdominal-wall hernias. Hernia. 2006;10(3):213–7.

    Article  PubMed  CAS  Google Scholar 

  23. Mathes SJ, Steinwald PM, Foster RD, Hoffman WY, Anthony JP. Complex abdominal wall reconstruction: a comparison of flap and mesh closure. Ann Surg. 2000;232(4):586–96.

    Article  PubMed  CAS  Google Scholar 

  24. King JN, Didlake RH, Gray RE. Giant inguinal hernia. South Med J. 1986;79(2):252–3.

    Article  PubMed  CAS  Google Scholar 

  25. Ammar SA. Management of giant ventral hernia by polypropylene mash and host tissue barrier: trial of simplification. J Clin Med Res. 2009;1(4):226–9.

    PubMed  Google Scholar 

  26. Ramirez OM, Ruas E, Dellon AL. Component separation method for closure of abdominal wall defects: an anatomic and clinic study. Plast Reconstr Surg. 1990;86:519–426.

    Article  PubMed  CAS  Google Scholar 

  27. 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.

  28. Munegato G, Grigoletto R, Brandolese R. Respiratory mechanics in abdominal compartment syndrome and large incisional hernias of the abdominal wall. Hernia. 2000;4:282–5.

    Article  Google Scholar 

  29. 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.

  30. Cheatham ML. Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome. World J Surg. 2009;33(6):1116–22.

    Article  PubMed  Google Scholar 

  31. Parra JA, Revuelta S, Gallego T, Bueno J, Berrio JI, Farinas MC. Prosthetic mesh used for inguinal and ventral hernia repair: normal appearance and complications in ultrasound and CT. Br J Radiol. 2004;77:261–5.

    Article  PubMed  CAS  Google Scholar 

  32. Chang EI, Foster RD, Hansen SL, Jazayeri L, Patti M. Autologous tissue reconstruction of ventral hernias in morbidly obese patients. Arch Surg. 2007;142:746–51.

    Article  PubMed  Google Scholar 

  33. Bingener J, Buck L, Richards M, Michalek J, Schwesinger W, Sirinek K. Long-term outcomes in laparoscopic vs open ventral hernia repair. Arch Surg. 2007;142:562–7.

    Article  PubMed  Google Scholar 

  34. Novitsky Y, Cobb W, Kercher K, Matthews B, Sing R, Heniford T. Laparoscopic ventral hernia repair in obese patient. Arch Surg. 2006;141(1):57–61.

    Article  PubMed  Google Scholar 

  35. Flancbaum L, Choban PS. Surgical implications of obesity. Annu Rev Med. 1998;49:215–34.

    Article  PubMed  CAS  Google Scholar 

  36. Lambert DM, Marceau S, Forse RA. Intra-abdominal pressure in the morbidly obese. Obes Surg. 2005;15(9):1225–32.

    Article  PubMed  Google Scholar 

  37. Leppaniemi A. Surgical management of abdominal compartment syndrome; indications and techniques. Scand J Trauma Resusc Emerg Med. 2009;17:17. doi:10.1186/1757-7241-17-17.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Clinic for General Surgery, Military Medical Academy, Crnotravska 17, 11000, Belgrade, Serbia

    M. Bezmarevic MD, D. Slavkovic MD, B. Trifunovic MD, PhD, N. Stankovic MD, PhD, S. Mickovic MD & B. Neskovic MD

  2. Clinic for Plastic and Reconstructive Surgery, Military Medical Academy, Belgrade, Serbia

    J. Beloica MD

Authors
  1. M. Bezmarevic MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Slavkovic MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. B. Trifunovic MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. N. Stankovic MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Mickovic MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. B. Neskovic MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Beloica MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Bezmarevic MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Bezmarevic, M., Slavkovic, D., Trifunovic, B. et al. Conservative treatment of abdominal compartment syndrome after large ventral hernia repair. Eur Surg 45, 31–36 (2013). https://doi.org/10.1007/s10353-012-0168-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10353-012-0168-6

Keywords

Search

Navigation