Abstract
Purpose
Abdominal wall hernias are a common problem. The success of abdominal wall reconstruction decreases with increasing hernia size. This study summarizes the outcomes of one surgeon’s experience using a “sandwich” technique for hernia repair in patients with loss of abdominal domain.
Methods
We reviewed our ventral hernia repair (VHR) experience from 2008 to 2015 among patients with loss of domain, as defined by a hernia defect greater than 300 cm2. The percent of herniation through the defect, defined by a hernia sac-to-abdominal cavity volume ratio, was measured on preoperative CT scans by four independent reviewers and averaged. Outcomes were compared among those with giant ventral hernias (hernia sac-to-abdominal cavity volume >30%) and those with smaller defect ratios.
Results
Over the study period, 21 patients underwent VHR. In 17 patients (81%), a “sandwich” technique was utilized. Ten patients had hernia sac-to-abdominal cavity defects less than 30%, and 11 had defects greater than 30%. Preoperative characteristics were similar in both groups with the exception of a higher ASA score in those with giant ventral hernias and more Ventral Hernia Working Group Grade 3 hernias in those without giant ventral hernias. Postoperative outcomes were similar in both groups. There were no mortalities. There were two recurrences (18%) in the giant VHR group and none in the smaller defect group (p = 0.16). Surgical site occurrences were noted in 48% of patients and did not differ between giant and non-giant VHR groups (50 vs 45%, p = 0.84). Average postoperative length of stay was significantly longer in the giant VHR group (31 vs. 17 days, p = 0.03).
Conclusions
Our results suggest that the “sandwich” technique for VHR is a safe and durable method to restore abdominal wall integrity in those with LOD, even in patients with giant ventral hernias.
Similar content being viewed by others
References
Itatsu K, Yokoyama Y, Sugawara G, Kubota H, Tojima Y, Kurumiya Y et al (2014) Incidence of and risk factors for incisional hernia after abdominal surgery. Br J Surg 101(11):1439–1447
Goodenough CJ, Ko TC, Kao LS, Nguyen MT, Holihan JL, Alawadi Z et al (2015) Development and validation of a risk stratification score for ventral incisional hernia after abdominal surgery: hernia expectation rates in intra-abdominal surgery (the HERNIA Project). J Am Coll Surg 220(4):405–413
Murray BW, Cipher DJ, Pham T, Anthony T (2011) The impact of surgical site infection on the development of incisional hernia and small bowel obstruction in colorectal surgery. Am J Surg 202(5):558–560
Passot G, Villeneuve L, Sabbagh C, Renard Y, Regimbeau JM, Verhaeghe P et al (2016) Definition of giant ventral hernias: development of standardization through a practice survey. Int J Surg 28:136–140
Tanaka EY, Yoo JH, Rodrigues AJ Jr, Utiyama EM, Birolini D, Rasslan S (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(1):63–69
Dumont F, Fuks D, Verhaeghe P, Brehant O, Sabbagh C, Riboulot M et al (2009) Progressive pneumoperitoneum increases the length of abdominal muscles. Hernia 13(2):183–187
Sabbagh C, Dumont F, Robert B, Badaoui R, Verhaeghe P, Regimbeau JM (2011) Peritoneal volume is predictive of tension-free fascia closure of large incisional hernias with loss of domain: a prospective study. Hernia 15(5):559–565
Sabbagh C, Dumont F, Fuks D, Yzet T, Verhaeghe P, Regimbeau JM (2012) Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A Prospect Study Hernia 16(1):33–40
von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP (2007) The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. PLoS Med 4(10):e296
Muysoms FE, Deerenberg EB, Peeters E, Agresta F, Berrevoet F, Campanelli G et al (2013) Recommendations for reporting outcome results in abdominal wall repair: results of a Consensus meeting in Palermo, Italy, 28–30 June 2012. Hernia 17(4):423–433
Muysoms F, Campanelli G, Champault GG, DeBeaux AC, Dietz UA, Jeekel J et al (2012) EuraHS: the development of an international online platform for registration and outcome measurement of ventral abdominal wall hernia repair. Hernia 16(3):239–250
Soares KC, Baltodano PA, Hicks CW, Cooney CM, Olorundare IO, Cornell P et al (2015) Novel wound management system reduction of surgical site morbidity after ventral hernia repairs: a critical analysis. Am J Surg 209(2):324–332
Bikhchandani J, Fitzgibbons RJ Jr (2013) Repair of giant ventral hernias. Adv Surg 47:1–27
Garcia A, Baldoni A (2015) Complex ventral hernia repair with a human acellular dermal matrix and component separation: a case series. Ann Med Surg (Lond) 4(3):271–278
Satterwhite TS, Miri S, Chung C, Spain D, Lorenz HP, Lee GK (2012) Outcomes of complex abdominal herniorrhaphy: experience with 106 cases. Ann Plast Surg 68(4):382–388
Breuing K, Butler CE, Ferzoco S, Franz M, Hultman CS, Kilbridge JF et al (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148(3):544–558
Kanters AE, Krpata DM, Blatnik JA, Novitsky YM, Rosen MJ (2012) Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 215(6):787–793
Berger RL, Li LT, Hicks SC, Davila JA, Kao LS, Liang MK (2013) Development and validation of a risk-stratification score for surgical site occurrence and surgical site infection after open ventral hernia repair. J Am Coll Surg 217(6):974–982
Rodriguez-Unda N, Soares KC, Azoury SC, Baltodano PA, Hicks CW, Burce KK et al (2015) Negative-pressure wound therapy in the management of high-grade ventral hernia repairs. J Gastrointest Surg 19(11):2054–2061
Jensen KK, Brondum TL, Harling H, Kehlet H, Jorgensen LN (2016) Enhanced recovery after giant ventral hernia repair. Hernia 20(2):249–256
Baltodano PA, Webb-Vargas Y, Soares KC, Hicks CW, Cooney CM, Cornell P et al (2016) A validated, risk assessment tool for predicting readmission after open ventral hernia repair. Hernia 20(1):119–129
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
TC declares no conflicts of interest, FA declares no conflicts of interest, KP declares no conflicts of interest, NF declares no conflicts of interest, PC declares no conflicts of interest, ON declares no conflicts of interest, SA declares no conflicts of interest, KS declares no conflicts of interest, CC declares no conflicts of interest, FE declares no conflicts of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.
Human and animal rights
The article does not contain any studies with animals performed by any of the authors.
Informed consent
Informed consent was obtained from all individual participants included in the study.
Additional information
F. K. Azar and T. C. Crawford contributed equally to the authorship of this manuscript.
Rights and permissions
About this article
Cite this article
Azar, F.K., Crawford, T.C., Poruk, K.E. et al. Ventral hernia repair in patients with abdominal loss of domain: an observational study of one institution’s experience. Hernia 21, 245–252 (2017). https://doi.org/10.1007/s10029-017-1576-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-017-1576-0