The abdominal compartment syndrome (ACS) is a clinical condition characterized by an increase of abdominal pressure which needs prompt i~ abdominal decompression. The surgery of large abdominal hernias can present similar problems with an increased abdominal pressure at peritoneal closure which needs a prosthetic tension-free abdominal closure to correct ~ the increased respiratory work-load. We undertook a study in order to com-~:i' il pare the respiratory mechanical work-load changes during the surgery of large abdominal incisional hernias and the ACS. We measured the static compliance of the entire respiratory system (Crs), and its components -lung (CL) and chest-wall (Ccw) -during the acute phase of increased abdominal pressure and after decompressive treatment. In ACS the baseline measurements i:~ of Crs, CL, Ccw were 0.034, 0.049 and o.115 L/cmH20 respectively; after decompression treatment we observed a great increase of Ccw (o.167 L/cmHzO) !~i whereas C1 remained the same (o.o49L/cmHzO); Crs varied from 0.034 to i I 0.038 L/cmH20. In the surgery of large laparoceles, the Crs changed from i~i:i 0.048 to 0.046 and the Ccw from o.15o to o.18o, with an unchanged C1. We .... conclude that the abdominal compartment syndrome is characterized by a i!~il well-defined alteration of respiratory work-load (decrease of chest-wall corn-:i~; pliance), and that from a mechanical point of view there is only a quantitative difference if compared to large ventral hernia repair. The decrease of chestwall compliance in the latter is less severe and statistically different ~!~ (p = o.oo~).~;
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