CAN INTRA-ABDOMINAL HYPERTENSION BE PREDICTED AFTER INCISIONAL HERNIA CORRECTION?
Intra-abdominal hypertension (IAH) leading to abdominal compartment syndrome (ACS- a condition that can impair the function of nearly every organ system) is a high mortality complication of incisional hernia repair. This review aims to present the current evidence on the relation between incisional hernia repair and the risk of developing IAH, and the impact of IAH on surgical care. IAH is defined by a sustained or repeated pathological elevation in intra-abdominal pressure (IAP) greater 12 mmHg. ACS has a high mortality rate, ranging from 40-100%, so it is important to: recognize the risk factors, use preventive techniques, monitor the intraabdominal pressure, and act early to decrease the pressure before it leads to organ dysfunctions. Hernia dependent risk factors are an incisional hernia volume/peritoneal volume calculated using volumetric CT calculation > 20% and a maximum transverse hernia diameter > 10cm. The reference standard for intermittent IAP measurements is via the bladder with a maximal instillation volume of 25mL of sterile saline. Recommend measures to reduce IAP both invasive and non-invasive: decompressive laparotomy in case of ACS, sedation and analgesia, neuromuscular blockade, body positioning, nasogastric/colonic decompression, promotility agents, diuretics and continuous renal replacement therapies, fluid resuscitation strategies, percutaneous catheter drainage (PCD), and different temporary abdominal closure (TAC) techniques among those requiring an open abdomen.