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

Azar, Faris; Crawford, Todd C.; Poruk, Katherine E.; Farrow, Norma E.; Cornell, Peter; Nadra, O.; Azoury, Saïd C.; Soares, Kevin C.; Cooney, Carisa M.; Eckhäuser, Frederic E.

doi:10.1007/s10029-017-1576-0

Cited by 25 publications

(20 citation statements)

References 22 publications

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“…Eight studies [ 11 , 25 , 26 , 44 , 46 , 51 , 58 , 59 ] reported the ratio of the hernia sac volume (HSV) to the abdominal cavity volume (ACV), commonly referred to as the Tanaka method [ 25 ]. Five studies [ 14 – 16 , 49 , 50 ] reported the ratio or percentage of the HSV to the total peritoneal volume (TPV = HSV + ACV), known as the Sabbagh method [ 15 ]. Four of the papers describe volumetric analyses but were unclear how LOD was calculated [ 19 , 48 , 56 , 60 ].…”

Section: Resultsmentioning

confidence: 99%

What Exactly is Meant by “Loss of Domain” for Ventral Hernia? Systematic Review of Definitions

Parker

Halligan²,

Blackburn

et al. 2018

World j. surg.

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Large ventral hernias are a significant surgical challenge. "Loss of domain" (LOD) expresses the relationship between hernia and abdominal volume, and is used to predict operative difficulty and success. This systematic review assessed whether different definitions of LOD are used in the literature. The PubMed database was searched for articles reporting large hernia repairs that explicitly described LOD. Two reviewers screened citations and extracted data from selected articles, focusing on the definitions used for LOD, study demographics, study design, and reporting surgical specialty. One hundred and seven articles were identified, 93 full-texts examined, and 77 were included in the systematic review. Sixty-seven articles were from the primary literature, and 10 articles were from the secondary literature. Twenty-eight articles (36%) gave a written definition for loss of domain. These varied and divided into six broad groupings; four described the loss of the right of domain, six described abdominal strap muscle contraction, five described the "second abdomen", five describing large irreducible hernias. Six gave miscellaneous definitions. Two articles gave multiple definitions. Twenty articles (26%) gave volumetric definitions; eight used the Tanaka method [hernia sac volume (HSV)/abdominal cavity volume] and five used the Sabbagh method [(HSV)/total peritoneal volume]. The definitions used for loss of domain were not dependent on the reporting specialty. Our systematic review revealed that multiple definitions of loss of domain are being used. These vary and are not interchangeable. Expert consensus on this matter is necessary to standardise this important concept for hernia surgeons.

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Section: Resultsmentioning

confidence: 99%

What Exactly is Meant by “Loss of Domain” for Ventral Hernia? Systematic Review of Definitions

Parker

Halligan²,

Blackburn

et al. 2018

World j. surg.

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“…In a study by Azar et al ( 14 ) 17 from 21 (81 %) patients with loss of domain hernias underwent a sandwich technique using Surgimend™ acellular dermal matrix and Prolene™ polypropylene mesh with additional negative-pressure wound vacuum. Ten patients had a hernia sac-to-abdominal cavity defect less than 30%, and 11 had defects greater than 30%.…”

Section: Resultsmentioning

confidence: 99%

Treatment of Large Incisional Hernias in Sandwich Technique - A Review of the Literature

Köckerling

Scheuerlein²,

Schug-Paß

2018

Front. Surg.

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IntroductionIn a systematic review of the surgical treatment of large incisional hernia sublay repair, the sandwich technique and aponeuroplasty with intraperitoneal mesh displayed the best results. In this systematic review only the sandwich technique, which used the hernia sac as an extension of the posterior and anterior rectus sheath and placement of a non-absorbable mesh in the sublay position, was included. Other modifications of the sandwich technique are published in the literature and were also analyzed in this literature review.MethodsA systematic search of the available literature was performed in November 2017 using Medline, PubMed, and the Cochrane Library using the terms “sandwich technique”, “double prosthetic repair”, “double mesh intraperitoneal repair”, and “component separation technique with double mesh”. This review is based on 24 relevant publications. Unfortunately, the evidence of the available studies is not very high since only prospective and retrospective case series have been published. There are no comparative studies at all. Therefore, the findings of the published case series must be viewed in a critical light.ResultsThe published studies report a remarkably low recurrence rate of 0-13% with a follow-up of 1–7 years. One limitation that must be mentioned here is that in around half of the studies the method of follow-up was not specified and in the remaining cases this was based on clinical examination by the surgical team. This puts into perspective the reported results, which appear to be too favorable given the complex nature of the hernias involved.The major disadvantage of the sandwich technique is a very high rate of wound complications of up to 68%, mainly induced by creation of large skin and subcutaneous cellular tissue flaps.ConclusionIt is difficult to evaluate the significance of the various modifications of the “sandwich technique” based on the available literature since it includes only case series and no comparative studies. The techniques used are associated with very high wound complication rates but with only relatively low recurrence rates despite the complexity of the cases involved. This must be verified in studies with a well-designed methodology.

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“…In terms of size, they defined CVH as “loss of domain” of 20% or more. Other authors have used a figure of 30% [11]. Loss of domain is increasingly important and describes the ratio of the hernia sac volume to the residual abdominopelvic cavity [12].…”

Section: Introductionmentioning

confidence: 99%

Imaging complex ventral hernias, their surgical repair, and their complications

et al. 2018

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Complex ventral hernia (CVH) describes large, anterior, ventral hernias. The incidence of CVH is rising rapidly due to increasing laparotomy rates in ever older, obese and co-morbid patients. Surgeons with a specific interest in CVH repair are now frequently referring these patients for imaging, normally computed tomography scanning. This review describes what information is required from preoperative imaging and the surgical options and techniques used for CVH repair, so that radiologists understand the postoperative appearances specific to CVH and are aware of the common complications following surgery.Key Points • Complex ventral hernia (CVH) describes large abdominal wall hernias (e.g. width ≥10cm). • CVH patients are being referred increasingly for preoperative and postoperative imaging. • Imaging is pivotal to characterise preoperative morphology and quantify loss of domain. • Postoperative imaging appearances are contingent on the surgical methods used for CVH repair. • Postoperative complications are depicted easily by imaging.

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

Abstract: 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.

Cited by 25 publications

References 22 publications

What Exactly is Meant by “Loss of Domain” for Ventral Hernia? Systematic Review of Definitions

What Exactly is Meant by “Loss of Domain” for Ventral Hernia? Systematic Review of Definitions

Treatment of Large Incisional Hernias in Sandwich Technique - A Review of the Literature

Imaging complex ventral hernias, their surgical repair, and their complications

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