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Ventral hernia repair in patients with abdominal loss of domain: an observational study of one institution’s experience

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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.

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Correspondence to F. K. Azar.

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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.

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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

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  • DOI: https://doi.org/10.1007/s10029-017-1576-0

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