title: Physiologic changes with abdominal wall reconstruction in a porcine abdominal compartment syndrome model.
abstract: OBJECTIVE
  Abdominal compartment syndrome (ACS) is a severe complication of ventral hernia repair. The aims of this study were to investigate the effects of intra-abdominal pressure on the physiologic changes of abdominal wall reconstruction and component separation in a porcine model.
  
  
  METHODS
  Ventral hernia repair (VHR) was simulated by abdominal fascial imbrication of a 10 × 15 cm defect in 45 Yorkshire pigs assigned to five experimental groups. ACS was simulated by a Stryker endoscopy insufflator with intra-abdominal pressure elevated to 20 mmHg in two groups. Component separation was performed in one of these groups and in one group without ACS. Physiological parameters were measured before and after the procedures and monitored for 4 h. The animals were euthanized for histologic analysis of organ damage.
  
  
  RESULTS
  VHR led to an increase in intra-abdominal pressure, bladder pressure, and central venous pressure by an average of 14.89, 13.93, and 14.69 mmHg (p < 0.001) in all animals. Component separation was performed in 25 animals and the three pressures reduced by 9.11, 8.00, 7.89 mmHg (p < 0.001). ACS correlated with higher percentages of large and small bowel necrosis compared to groups without abdominal compartment syndrome.
  
  
  CONCLUSIONS
  The results confirm that primary repair of large abdominal wall defects leads to increased intra-abdominal pressure, which can be reduced with component separation. In animals with ACS, component separation may reduce the risk of organ damage. Central venous pressure, bladder pressure, and other physiologic parameters accurately correlated with elevated intra-abdominal pressure and may have utility as markers for diagnosis of ACS.
authors.affiliation: Division of Plastic, Reconstructive and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, Baltimore, MD, USA.
authors.forename: R
authors.initials: R
authors.lastname: Mohan
authors.forename: H G
authors.initials: HG
authors.lastname: Hui-Chou
authors.forename: H D
authors.initials: HD
authors.lastname: Wang
authors.forename: A J
authors.initials: AJ
authors.lastname: Nam
authors.forename: M
authors.initials: M
authors.lastname: Magarakis
authors.forename: G S
authors.initials: GS
authors.lastname: Mundinger
authors.forename: E N
authors.initials: EN
authors.lastname: Brown
authors.forename: A J
authors.initials: AJ
authors.lastname: Kelamis
authors.forename: M R
authors.initials: MR
authors.lastname: Christy
authors.forename: E D
authors.initials: ED
authors.lastname: Rodriguez
mesh_terms: D034841:Abdominal Cavity / Q000503:physiopathology; D034861:Abdominal Wall / Q000601:surgery*; D000818:Animals; D004195:Disease Models, Animal; D000071938:Fasciotomy; D005260:Female; D059685:Herniorrhaphy; D059325:Intra-Abdominal Hypertension / Q000503:physiopathology* / Q000601:surgery; D011312:Pressure; D013552:Swine