Sunday, October 25, 2009 - 10:10 AM
16095

A Prospective Study of Changes In Abdominal Volume and Pulmonary Function Following Separation of Parts Repair for Massive Ventral Hernias

Sonya Paisley Agnew, MD, William Small, MD, Edward Wang, PhD, Lewis Smith, MD, Ivan Hadad, MD, Gregory A. Dumanian, MD, and Suzannne Diment, RN.

Introduction:

Immediate post-operative abdominal compartment syndrome is a feared complication after repair of massive ventral hernias, and has been reported in up to 30% of patients who have had a “loss of abdominal domain”.  i, ii, ,[i],[ii],[iii],[iv]  Replacement of the viscera within an unyielding stiff abdominal wall may compromise the perfusion of the intestines, elevate the diaphragm, and interfere with ventilation.  The “Separation of Parts” technique employs bilateral relaxing incisions in the external oblique muscle and fascia in order to reapproximate the rectus abdominis muscles in the midline.  An additional benefit may be to improve abdominal wall compliance and volume, thus preventing diaphragm elevation.  The purpose of this study was to prospectively analyze the effect of this surgical technique on abdominal volume and pulmonary function.

 

Methods:

Nineteen consecutive patients with large ventral hernias were enrolled from the senior surgeon’s practice.  Intra-abdominal volumes were prospectively measured before and after hernia repair using computer analysis of abdominal CT scans.  Pulmonary function tests administered before and after surgery were interpreted by blinded members of the Department of Pulmonology.  Routine patient demographics, clinical characteristics and postoperative course including cardio-pulmonary and wound complications, quality of life, and incidence of recurrence were prospectively collected.  Statistical analysis was performed using paired student’s t-test where applicable.

 

 

[i] Dibello JN, Moore JH.  Sliding myofascial flap of the rectus abdominus muscles for the closure of recurrent ventral hernias.  Plast Reconstr Surg 1996; 98 (3): 464-469
[ii] De Vries Reilingh TS, van Goor H, et al. Component separation technique for the repair of large abdominal wall hernias.  J Am Coll Surg 2003; 196 (1): 32-37
[iii] Tobias AM, Low DW.  The use of a subfascial vicryl mesh buttress to aid in the closure of massive ventral hernias following damage-control laparotomy.  Plast Reconstr Surg 2003; 112 (3): 766-775.
[iv] Paajanen H, Laine H.  Operative treatment of massive ventral hernia using polypropylene mesh: A challenge for surgeon and anesthesiologist.  Hernia 2005; 9 (1) 62-67. 

 Results:
The group was made up of 9 women and 10 men with an average age of 53.4 years (range 24-76) and BMI of 29.9 kg/m2.  Seven of the nineteen patients had abnormal pulmonary function on pre-operative testing. Average hernia size was 914.5 ml.  Intra-abdominal volume increased significantly after separation of parts hernia repair from an average of 7639.7 ml to 8165.6 ml (p= 0.01).  Diaphragm height did not change significantly (37.1 cm to 37.5cm, p=0.42).  Intraoperative peak airway pressures remained within normal limits for all patients.  Pulmonary function testing revealed no significant differences before and after surgery.  Specifically, there were no differences detected in MVV, FVC, FEV1, TLC, RV, VC, IC, or ERV (p>0.1).  One patient with a prior history of CVA suffered an ischemic stroke at home on post-operative day 28.  There were 3 wound complications; all were managed with local wound care and closure by secondary intention.  Average length of hospital stay was 7.3 days.  Patient self-reported ability to perform vigorous and moderate physical activity improved by 18% although this did not reach statistical significance. 

 Conclusions:
Separation of parts hernia repairs act to restore lost abdominal domain.  This technique can be performed on patients with large volume ventral hernias without adverse effect on pulmonary mechanics.  

 

See more of Reconstructive 2b
See more of General Reconstruction

Back to 2009am Complete Scientific Program