Patients with ventral hernia and loss of domain represent some of the most complex hernia a surgeon may face. Loss of domain is where 50 % of the abdominal viscera reside outside the abdominal cavity. Emergency surgery with open abdomen management and morbid obesity with prior open abdominal surgery are the two most common reasons for loss of domain development. Restoring abdominal wall integrity and function via a hernia repair poses special consideration from a preoperative preparation and operative technique standpoint. Preoperative weight loss may decrease the intra-abdominal volume for the viscera to return at the time of the repair. Smoking cessation, wound care, exercise training, and diabetes management can reduce postoperative pulmonary and wound infections. In most cases, myofascial releases that lengthen the abdominal wall are necessary to optimized primary fascial closure of the abdomen. There are multiple surgical techniques that can be combined to enhance mesh implantation and restoration of abdominal wall function.
Loss of domain Management Strategy Abdominal wall Fascia Advancement Component separation Incisional hernia Adipocutaneous Myofascial Rectus abdominis Eternal oblique Internal oblique Transversus abdominis Pre-peritoneal Ramirez Novitsky Chevrel
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Stokes IA, Gardner-Morse MG, Henry SM. Intra-abdominal pressure and abdominal wall muscular function: spinal unloading mechanism. Clin Biomech. 2010;25(9):859–66.CrossRefGoogle Scholar
Ramirez OM, Ko MJ, Dellon AL. “Components separation” method for closure of abdominal wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990;86:519–26.CrossRefPubMedGoogle Scholar
Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ. Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg. 2012;204(5):709–16.CrossRefPubMedGoogle Scholar
Mcadory RS, Cobb WS, Carbonell AM. Progressive preoperative pneumoperitoneum for hernias with loss of domain. Am Surg. 2009;75(6):504–8.PubMedGoogle Scholar
Agnew SP, Small W, Wang E, Smith LJ, Hadad I, Dumanian GA. Prospective measurements of intra-abdominal volume and pulmonary function after repair of massive ventral hernias with the components separation technique. Ann Surg. 2010;251(5):981–8.CrossRefPubMedGoogle Scholar
Gaidukov KM, Raibuzhis EN, Hussain A, Teterin AY, Smetkin AA, Kuzkov VV, Malbrain ML, Kirov MY. Effect of intra-abdominal pressure on respiratory function in patients undergoing ventral hernia repair. World J Crit Care Med. 2013;2(2):9–16.CrossRefPubMedPubMedCentralGoogle Scholar