pp 1–7 | Cite as

New, simple and reliable volumetric calculation technique in incisional hernias with loss of domain

  • P. Martre
  • M. Sarsam
  • J.-J. Tuech
  • J. Coget
  • L. SchwarzEmail author
  • H. Khalil



The management of hernias with loss of domain is a challenging problem. It has been shown that the volume of the incisional hernia/peritoneal volume ratio < 20% was a predictive factor for tension-free fascia closure, after pre-operative pneumoperitoneum preparation (Goni Moreno technique). In this study, we propose an easy, reliable and fast technique to perform volumetric calculation, by the surgeon alone.

Materials and methods

3D slicer software (free open-source software) was used to calculate with precision the intra-peritoneal and intra-hernia volumes, and to create a 3D reconstruction of both volumes. The measurement technique is described step by step using detailed figures and videos.


The method was used to calculate the volumes for five consecutive patients, managed between January 2018 and March 2019. All the five patients had a ratio greater than 20% and, therefore, received a PPP program. The effectiveness of the procedure is objectified by the increase of the intraabdominal volume and the reduction of the incisional hernia/peritoneal volume ratio. The feasibility of a tension-free fascia closure was confirmed for the five patients.


In addition to a standardized definition of “loss of domain”, a standardized volumetric technique, easy to reproduce, needs to be adopted. Our method can be done by any surgeon with basic computer skills and radiological knowledge in an autonomous and a fast manner, thus helping to select the right technique for the right patient.


Goni Moreno technique Incisional hernia Loss of domain Volumetry 3D Slicer 


Compliance with ethical standards


There was no funding source for this study.

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

The institutional review board of Rouen University hospital approved this study.

Human and animal rights

This article does not contain any studies with human participants performed by any of the authors.

Informed consent

Informed consent was signed by all patients included.

Supplementary material

Supplementary file1 (MP4 31306 kb)


  1. 1.
    Renard Y, Lardière-Deguelte S, de Mestier L et al (2016) Management of large incisional hernias with loss of domain: a prospective series of patients prepared by progressive preoperative pneumoperitoneum. Surgery 160:426–435. CrossRefPubMedGoogle Scholar
  2. 2.
    Sabbagh C, Dumont F, Fuks D et al (2012) Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study. Hernia 16:33–40. CrossRefPubMedGoogle Scholar
  3. 5.
    Rakower SR (2011) Intentional progressive preoperative pneumoperitoneum for adhesiolysis in the hostile surgical abdomen. Am Surg 77:E193–194PubMedGoogle Scholar
  4. 6.
    Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526CrossRefGoogle Scholar
  5. 7.
    Eriksson A, Rosenberg J, Bisgaard T (2014) Surgical treatment for giant incisional hernia: a qualitative systematic review. Hernia 18:31–38. CrossRefPubMedGoogle Scholar
  6. 3.
    Goni Moreno I (1951) Rational treatment of chronic massive hernias and eventrations; preparation of a patient with progressive pneumoperitoneum; original technic. Prensa Med Argent 38:10–21PubMedGoogle Scholar
  7. 4.
    Dumont F, Fuks D, Verhaeghe P et al (2009) Progressive pneumoperitoneum increases the length of abdominal muscles. Hernia 13:183–187. CrossRefPubMedGoogle Scholar
  8. 8.
    Sabbagh C, Dumont F, Robert B et al (2011) Peritoneal volume is predictive of tension-free fascia closure of large incisional hernias with loss of domain: a prospective study. Hernia 15:559–565. CrossRefPubMedGoogle Scholar
  9. 9.
    Tanaka EY, Yoo JH, Rodrigues AJ et al (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 14:63–69. CrossRefPubMedGoogle Scholar
  10. 10.
    Parker SG, Halligan S, Blackburn S et al (2018) What exactly is meant by “loss of domain” for ventral hernia? Systematic review of definitions. World J Surg. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • P. Martre
    • 1
  • M. Sarsam
    • 2
  • J.-J. Tuech
    • 1
  • J. Coget
    • 1
  • L. Schwarz
    • 1
    Email author
  • H. Khalil
    • 1
  1. 1.Department of Digestive SurgeryRouen University HospitalRouenFrance
  2. 2.Department of General and Thoracic SurgeryRouen University HospitalRouenFrance

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