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

Abstract

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.

Preoperative Botulinum Toxin and Progressive Pneumoperitoneum in Loss of Domain Hernias—Our First 100 Cases

“…Loss of domain hernia (LODH) represents a challenge for the abdominal wall surgeon. Continuous persistence of a significant part of the intestinal package in the hernia sac may cause respiratory disorders, physiological alterations, and lifestyle changes in these patients (1).…”

What exactly is meant by ‘loss of domain’ for ventral hernia? A survey of 100 surgeons

“…The term ‘loss of domain’ (LOD) is used widely amongst surgeons to describe the relationship between ventral hernia (VH) volume and residual abdominopelvic cavity volume; hernias with significant LOD are difficult to repair and are more likely to recur . However, the term appears loosely defined: A recent systematic review demonstrated considerable confusion, finding multiple different written and volumetric definitions . For LOD to be a useful surgical concept, for example to predict post‐operative recurrence, its definition should be standardized and applied consistently.…”

Definitions for Loss of Domain: An International Delphi Consensus of Expert Surgeons

“…The panelists were asked to vote on a threshold value for LOD, above which they believed the risk of postoperative complications becomes clinically significant, and therefore the value above which they might consider not operating at all. The written and volumetric definitions of LOD were taken from those identified by a recent systematic review [7]. Four written definitions and two volumetric definitions were identified.…”

“…Figures were presented as frequencies and percentages. We anticipated that establishing a written definition for LOD would be difficult as we believed previously published definitions were convoluted, counterintuitive and unlikely to reach consensus [7]. We recognized that it may be necessary to suggest new definitions in order to achieve consensus.…”