The intraabdominal pressure A real indicator of the tension free principle during anterior wall repair procedure after incisional hernias

Abstract

AIM: Incisional hernias represent a late onset complication of any type of laparotomy, with a relatively high incidence, and reported in 2% to 11% of all laparotomies.

MATERIAL AND METHODS. We performed a prospective longitudinal study that included a total number of 102 patients. The following parameters were monitored: patient history clinical findings, time of hospitalization, laboratory test results, types of surgery. Intra-abdominal pressure variations were measured using a specialized kit.

RESULTS: Obesity was present in 69 of the patients (67.64%). Mesh plasty was most frequently used (80.39%). The inset of the mesh was performed in onlay position (40.19%), retromuscular (29.98%) or complete defect substitution (11.76%). The correlation between the type of abdominal wall plasty, variations on the Borg dyspnea scal and likewise the correlation between the VAS (visual analogue scale) pain scale and the abdominal wall plasty procedures proved to be highly statistically significant: p< 0.001. Furthermore, the intra-abdominal pressure varied with the type of abdominoplasty carried out, reviewing the tension free principle. The most important parameter was the intra-abdominal pressure recorded at the end of the abdominoplasty, which showed significant correlations with the tension free plasties (retromuscular mesh and substitution mesh).

CONCLUSIONS: The tension free methods, reflected by the intra-abdominal pressure variation, were associated with a lower degree of dyspnea, low postoperative pain and less hospitalization time.