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



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.



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).



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.
Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD, 21287, USA. fazar1@jhmi.edu.
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Azar
Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Crawford
Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Poruk
School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
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Farrow
Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Cornell
Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Nadra
Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Azoury
Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Soares
Department of Plastic and Reconstructive Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
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Cooney
Department of Surgery, The Johns Hopkins Hospital, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Eckhauser
D034841:Abdominal Cavity / Q000000981:diagnostic imaging / Q000473:pathology; D034861:Abdominal Wall / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D062088:Acellular Dermis; D005260:Female; D006555:Hernia, Ventral / Q000000981:diagnostic imaging / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D012189:Retrospective Studies; D013526:Surgical Mesh
Abdominal ventral hernia; Incisional hernia; Loss of domain