Asian J Endosc Surg. 2026 Jan-Dec;19(1):e70386. doi: 10.1111/ases.70386.
ABSTRACT
PURPOSE: Reduction of chronically herniated viscera and restoration of midline continuity in a large incisional hernia can raise intra-abdominal pressure (IAP), occasionally to the point of intra-abdominal hypertension. Component separation is intended to mitigate this by increasing the capacity and compliance of the abdominal wall, yet the perioperative pressure profile of endoscopic anterior component separation combined with intraperitoneal onlay mesh repair with fascial closure (IPOM-plus) has not been well characterized. We measured IAP and airway pressure across the perioperative period in patients undergoing this reconstruction.
METHODS: Thirty consecutive adults with a midline incisional hernia of at least 6 cm width underwent bilateral endoscopic anterior component separation with primary fascial closure and IPOM-plus repair at a tertiary center. IAP was measured indirectly as intravesical pressure (IVP) at four predefined time points: preoperatively, immediately after induction of anesthesia, after completion of the reconstruction before anesthetic reversal, and 24 h postoperatively. Peak airway pressure (Paw) was recorded after induction and before reversal. Loss of domain was quantified on preoperative computed tomography using the Tanaka method. The primary outcome was the change in IVP from the preoperative measurement to 24 h. Repeated measures were compared using the Friedman test with post hoc Wilcoxon signed-rank tests and Bonferroni correction.
RESULTS: Mean IVP was 9.43 ± 1.01 mmHg preoperatively, 8.67 ± 0.84 mmHg after induction, 8.87 ± 0.82 mmHg before reversal and 9.93 ± 1.05 mmHg at 24 h, differing significantly overall (Friedman χ2(3) = 46.06, p < 0.001; Kendall W = 0.51). The primary outcome, the preoperative to 24-h change, was an increase of 0.50 ± 0.68 mmHg, which was statistically significant (adjusted p = 0.006) but clinically negligible. Two patients (6.7%) reached 12 mmHg and so met the threshold for Grade I intra-abdominal hypertension, and none developed organ dysfunction. IVP did not change significantly during the surgery itself (8.67-8.87 mmHg, adjusted p = 0.347). Paw was unchanged (19.60 ± 1.22 to 19.53 ± 1.11 cmH2O, p = 0.564), as were FVC, FEV1 and FEV1/FVC. The Tanaka score (mean 25.7 ± 1.1%) was not associated with IVP at any time point or with the change in IVP. Fascial closure was achieved in all 30 patients, and 30-day morbidity comprised one seroma and one abdominal wall ecchymosis, both Clavien-Dindo Grade I.
CONCLUSION: Endoscopic anterior component separation with fascial closure and IPOM-plus repair was not accompanied by a meaningful rise in intra-abdominal or airway pressure. The statistically significant 24-h increase of 0.5 mmHg is unlikely to be clinically relevant, and respiratory mechanics were preserved. Within the narrow range of loss of domain studied, the Tanaka score did not predict the perioperative pressure response.
PMID:42816070 | DOI:10.1111/ases.70386