Experience with insufflation technique in the management of incisional hernia with loss of domain

Abstract

Background: The loss of intra-abdominal domain makes it impossible to reconstruct the abdominal wall defect without prior correction of container/content mismatch. This study reports on the use of an insufflation technique to enable repair.
Method: Over an 8-year period, 19 incisional hernia patients with loss of domain between 20% and 50% were treated with an insufflation technique to create sufficient intra-abdominal domain to effect repair. Ambient air was insufflated into the abdominal cavity via an indwelling catheter. After progressive pneumoperitoneum was completed over a period of 10 to 14 days, the hernias were repaired.
Results: There were 16 females and three males. The defect size ranged from 7–25 cm. The mean air insufflated was 7.2 litres. After pneumoperitoneum, approximation of the linea alba was possible in all cases with a mean intraoperative predeflation and post-closure peak airway pressure within normal (21 and 20 cmH2O respectively). Tissue repair and implant reinforcement were performed in 17 and two cases respectively. There were three instances of surgical site complications and no 30-day recurrence.
Conclusion: Repair of incisional hernia with significant loss of domain was made possible by the insufflation technique that enabled tension-free closure of the abdominal wall defect by direct suture, evidenced by the normal peak airway pressure after closure.