Assessing the respiratory impact caused when giant hernias are reinserted into the abdominal cavity, in order to determine the optimal surgical approach

Francisco Javier Pérez Lara Francisco Javier Pérez Lara,Francisco Javier Moya Donoso Francisco Javier Moya Donoso,Tatiana Prieto-Puga Tatiana Prieto-Puga,José Manuel Hernández González José Manuel Hernández González,José Jesús Pérez Parras José Jesús Pérez Parras,Mariangeles Madueño Guerrero Mariangeles Madueño Guerrero

doi:10.30574/wjarr.2020.8.2.0445

Francisco Javier Pérez Lara Francisco Javier Pérez Lara, Francisco Javier Moya Donoso Francisco Javier Moya Donoso + Show 4 more

Open Access

https://doi.org/10.30574/wjarr.2020.8.2.0445

Copy DOI

Abstract

The reinsertion of a large hernia into the abdominal cavity provokes an increase in abdominal volume and pressure that can result in intra-abdominal hypertension. This, in turn, may generate a series of complex changes in cardiopulmonary physiology and induce severe respiratory insufficiency. At present, no objective method exists to evaluate the possibility of this respiratory complication occurring. Accordingly, the present study was undertaken to measure the respiratory consequences of abdominal volume restriction. The data obtained were used to construct a reference table, from which the reduction in FEV1 can be predicted according to the hernia volume reinserted. Thus, the surgeon has access to more accurate information, which greatly facilitates the treatment of large abdominal hernias.

Highlights

In all laparotomies, the incidence of incisional hernias is 20%, with a known risk ranging from 14% to 20% [1,2]
The reinsertion of a large hernia into the abdominal cavity provokes an increase in abdominal volume and pressure that can result in intra-abdominal hypertension
Patients are considered operable if forced expiratory volume in 1 second (FEV1)-ppo >40% [12]. The value of this parameter as a predictor of postsurgical respiratory complications in abdominal surgery has not yet been validated [13], but until it is, we believe it reasonable to use it as a cut-off point, considering the anatomical and functional relationships between the abdominal and thoracic cavities and the mounting evidence that changes in abdominal pressure are transmitted to the thorax

Summary

Introduction

The incidence of incisional hernias is 20%, with a known risk ranging from 14% to 20% [1,2]. Abstract The reinsertion of a large hernia into the abdominal cavity provokes an increase in abdominal volume and pressure that can result in intra-abdominal hypertension. Surgery is dangerous due to the risk of acute postoperative respiratory failure following the displacement of the large hernial content from the abdominal cavity.

Results

Conclusion