Plastic Surgery Research Council
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Presenter: Howard D Wang
Co-Authors: Chou HH; Mohan R; Nam AJ; Magarakis M; Mundinger GS; Brown EN; Kelamis JA; Jones LS; Drachenberg C; Price LA; Christy MR; Rodriguez ED
Johns Hopkins University and University of Maryland

INTRODUCTION: Abdominal compartment syndrome (ACS) is a severe complication of large ventral hernia repairs. The aims of this study were to investigate the effects of intra-abdominal pressure on the physiologic changes of primary ventral hernia repair (VHR) and components separation (CS) in a porcine model.

METHODS: VHR was simulated by abdominal fascial imbrications of a 10x15 cm defect. Forty-five Yorkshire pigs were divided into five groups (Figure 1). Group 1 received VHR alone; group 2 underwent VHR and had ACS; group 3 received VHR and CS; group 4 had VHR, CS, and ACS; group 5 had VHR, CS, and mild ACS. CS was performed by division of external oblique muscles. ACS was modeled by using Stryker endoscopy insufflator to elevate intrabdominal pressure (IAP) to 20 mmHg. IAP, bladder pressure (BLP), and femoral central venous pressure (CVP) were measured before and after VHR and CS. Physiologic parameters were monitored for four hours. Animals were desufflated, recovered and euthanized for histologic analysis of organ damage.

RESULTS: Significant changes in IAP, BLP, and CVP resulted from both interventions. VHR led to an increase in all three by an average of 14.89, 13.93, and 14.69 mmHg, respectively (p<0.01). After CS, the pressures decreased by 9.11, 8.00, 7.89 mmHg, respectively (p<0.01) as shown in Figure 2. Significant differences in CVP, BLP, peak inspiratory pressure (PIP), and mean airway pressure (MAP) were observed between animals with ACS and those without. Within the subset with ACS, CS did not result in significant changes in the measured physiologic parameters compared to VHR alone but did lead to a significantly lower incidence of animals with large bowel necrosis (29% vs. 87%). See Figure 3 for details.

CONCLUSIONS: The results confirm that primary repair of large abdominal wall defects leads to an increase in IAP, which can be reduced with separation of components. In animals with ACS, CS may reduce the risk of organ damage. CVP, BLP, PIP, and MAP accurately correlated with elevated IAP and may be used as surrogate markers for diagnosis of ACS.

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