European Surgery

, Volume 45, Issue 1, pp 31–36 | Cite as

Conservative treatment of abdominal compartment syndrome after large ventral hernia repair

  • M. Bezmarevic
  • D. Slavkovic
  • B. Trifunovic
  • N. Stankovic
  • S. Mickovic
  • B. Neskovic
  • J. Beloica
Case Report

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.

Keywords

Large, ventral, hernia Repair Abdominal, compartment, syndrome Treatment 

References

  1. 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. 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.PubMedGoogle Scholar
  3. 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.PubMedCrossRefGoogle Scholar
  4. 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).PubMedGoogle Scholar
  5. 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.PubMedCrossRefGoogle Scholar
  6. 6.
    Langer S, Christiansen J. Long-term results after incisional hernia repair. Acta Chir Scand. 1985;151:217–9.PubMedGoogle Scholar
  7. 7.
    Anthony T, Bergen PC, Kim LT. Factors affecting recurrence following incisional herniorrhaphy. World J Surg. 2000;24(1):95–101.PubMedCrossRefGoogle Scholar
  8. 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.PubMedCrossRefGoogle Scholar
  9. 9.
    Deysine M. Ventral herniorrhaphy: treatment evolution in a hernia service. Hernia. 1998;2:15–8.CrossRefGoogle Scholar
  10. 10.
    Shell DH, Torre J, Andrades P, Vasconez LO. Open repair of ventral incisional hernias. Surg Clin N Am. 2008;88:61–3.PubMedCrossRefGoogle Scholar
  11. 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.PubMedCrossRefGoogle Scholar
  12. 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.PubMedCrossRefGoogle Scholar
  13. 13.
    An G, West MA. Abdominal compartment syndrome: a concise clinical review. Crit Care Med. 2008;36:1304–10.PubMedCrossRefGoogle Scholar
  14. 14.
    Milev B, Mirkovic D, Bezmarevic M, et al. Intra-abdominal hypertension and abdominal compartment syndrome. Vojnosanit Pregl. 2010;67(8):674–80.PubMedCrossRefGoogle Scholar
  15. 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.PubMedCrossRefGoogle Scholar
  16. 16.
    Schachtrupp A, Hoer J, Tons C, et al. Intra-abdominal pressure: a reliable criterion for laparostomy closure? Hernia. 2002;6:102–7.Google Scholar
  17. 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/.Google Scholar
  18. 18.
    Cheatham ML, Safcsak K. Intraabdominal pressure: a revised method for measurement. J Am Coll Surg. 1998;186:594–5.PubMedCrossRefGoogle Scholar
  19. 19.
    Cassar K, Munro A. Surgical treatment of incisional hernia. Br J Surg. 2002;89:534–45.PubMedCrossRefGoogle Scholar
  20. 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.PubMedCrossRefGoogle Scholar
  21. 21.
    Raynor RW, Del Guercio LR. The place for pneumoperitoneum in the repair of massive hernia. World J Surg. 1989;13(5):581–5.PubMedCrossRefGoogle Scholar
  22. 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.PubMedCrossRefGoogle Scholar
  23. 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.PubMedCrossRefGoogle Scholar
  24. 24.
    King JN, Didlake RH, Gray RE. Giant inguinal hernia. South Med J. 1986;79(2):252–3.PubMedCrossRefGoogle Scholar
  25. 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.PubMedGoogle Scholar
  26. 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.PubMedCrossRefGoogle Scholar
  27. 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.Google Scholar
  28. 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.CrossRefGoogle Scholar
  29. 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.Google Scholar
  30. 30.
    Cheatham ML. Nonoperative management of intraabdominal hypertension and abdominal compartment syndrome. World J Surg. 2009;33(6):1116–22.PubMedCrossRefGoogle Scholar
  31. 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.PubMedCrossRefGoogle Scholar
  32. 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.PubMedCrossRefGoogle Scholar
  33. 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.PubMedCrossRefGoogle Scholar
  34. 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.PubMedCrossRefGoogle Scholar
  35. 35.
    Flancbaum L, Choban PS. Surgical implications of obesity. Annu Rev Med. 1998;49:215–34.PubMedCrossRefGoogle Scholar
  36. 36.
    Lambert DM, Marceau S, Forse RA. Intra-abdominal pressure in the morbidly obese. Obes Surg. 2005;15(9):1225–32.PubMedCrossRefGoogle Scholar
  37. 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.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2012

Authors and Affiliations

  • M. Bezmarevic
    • 1
  • D. Slavkovic
    • 1
  • B. Trifunovic
    • 1
  • N. Stankovic
    • 1
  • S. Mickovic
    • 1
  • B. Neskovic
    • 1
  • J. Beloica
    • 2
  1. 1.Clinic for General SurgeryMilitary Medical AcademyBelgradeSerbia
  2. 2.Clinic for Plastic and Reconstructive SurgeryMilitary Medical AcademyBelgradeSerbia

Personalised recommendations