New, simple and reliable volumetric calculation technique in incisional hernias with loss of domain



The management of hernias with loss of domain is a challenging problem. It has been shown that the volume of the incisional hernia/peritoneal volume ratio < 20% was a predictive factor for tension-free fascia closure, after pre-operative pneumoperitoneum preparation (Goni Moreno technique). In this study, we propose an easy, reliable and fast technique to perform volumetric calculation, by the surgeon alone.

Materials and methods

3D slicer software (free open-source software) was used to calculate with precision the intra-peritoneal and intra-hernia volumes, and to create a 3D reconstruction of both volumes. The measurement technique is described step by step using detailed figures and videos.


The method was used to calculate the volumes for five consecutive patients, managed between January 2018 and March 2019. All the five patients had a ratio greater than 20% and, therefore, received a PPP program. The effectiveness of the procedure is objectified by the increase of the intraabdominal volume and the reduction of the incisional hernia/peritoneal volume ratio. The feasibility of a tension-free fascia closure was confirmed for the five patients.


In addition to a standardized definition of “loss of domain”, a standardized volumetric technique, easy to reproduce, needs to be adopted. Our method can be done by any surgeon with basic computer skills and radiological knowledge in an autonomous and a fast manner, thus helping to select the right technique for the right patient.

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Author information

Correspondence to L. Schwarz.

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There was no funding source for this study.

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

The institutional review board of Rouen University hospital approved this study.

Human and animal rights

This article does not contain any studies with human participants performed by any of the authors.

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Informed consent was signed by all patients included.

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Martre, P., Sarsam, M., Tuech, J. et al. New, simple and reliable volumetric calculation technique in incisional hernias with loss of domain. Hernia (2019).

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  • Goni Moreno technique
  • Incisional hernia
  • Loss of domain
  • Volumetry
  • 3D Slicer