title: Peritoneal volume is predictive of tension-free fascia closure of large incisional hernias with loss of domain: a prospective study.
abstract: BACKGROUND
  The surgical treatment of large incisional hernias with loss of domain (LIHLD) carries the risk of fascia closure under tension and, thus, abdominal compartment syndrome. We investigated volume measurements as a predictive factor for tension-free fascia closure.
  
  
  METHODS
  From September 2004 to July 2008, we prospectively included 17 patients with LIHLD. The operation was prepared by a progressive preoperative pneumoperitoneum (PPP) technique known as the Goni Moreno procedure. The patient's age and body mass index (BMI), the incisional hernia's width, length and surface area, and the incisional hernia volume (IHV)/peritoneal volume (PV) ratio <20% were evaluated as predictive factors for tension-free fascia closure. A tension-free closure was defined as a closure in which the use of a surgical device for avoiding postoperative compartment syndrome was not required.
  
  
  RESULTS
  The mean PPP volume introduced was 12.7 ± 4.4 l (range 4.5-19.2) over a period of 11 ± 6 days (range 4-24). The mean width, height and surface area of the incisional hernia after PPP were 11.3 ± 4.7 cm (range 4.5-19), 13.4 ± 7.8 cm (range 4.4-30) and 165 ± 101 cm(2) (range 19-304), respectively. The mean IHV after PPP was 2,374 ± 1,356 cc (range 517-4,802) and the mean abdominal cavity volume was 9,558 ± 4,106 cc (range 4,785-21,782). The mean IHV/PV ratio was 16.3 ± 10.4% (range 4.4-34). In a univariate analysis, the BMI and the IHV/PV ratio were predictive of tension-free fascia closure. In a multivariate analysis, only an IHV/PV ratio <20% was a significant predictive factor.
  
  
  CONCLUSIONS
  The IHV/PV ratio is predictive of tension-free fascia closure for hernias or incisional hernias with loss of domain. Simplification of the volumetry method is necessary.
authors.affiliation: Department of Digestive Surgery, Amiens University Hospital and Jules Verne University of Picardy, Place Victor Pauchet, 80054 Amiens cedex 01, France.
authors.forename: C
authors.initials: C
authors.lastname: Sabbagh
authors.forename: F
authors.initials: F
authors.lastname: Dumont
authors.forename: B
authors.initials: B
authors.lastname: Robert
authors.forename: R
authors.initials: R
authors.lastname: Badaoui
authors.forename: P
authors.initials: P
authors.lastname: Verhaeghe
authors.forename: J-M
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000071938:Fasciotomy; D005260:Female; D046449:Hernia, Abdominal / Q000473:pathology* / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009929:Organ Size; D010529:Peritoneal Cavity / Q000033:anatomy & histology*; D011028:Pneumoperitoneum, Artificial; D011237:Predictive Value of Tests; D011446:Prospective Studies; D058106:Wound Closure Techniques