Tension free repair model for severe abdominal wall defects using intraoperative monitoring of the intraabdominal pressure

AIM: Parietal sutures performed under tension and elevated values of intraabdominal pressure are key elements in the evolution of incisional hernias. The study presents a tension free reconstruction model of the abdominal wall monitored through intraoperative recording of the intraabdominal pressure using the transvesical method. MATERIAL AND METHOD: We present the case of a female patient with recurrent voluminous midline incisional hernia. A dedicated kit (AbViserTM) connected to the bladder catheter had been used for recording intraabdominal pressure during the procedure. The chosen parietal reconstruction method was reconstruction with placement of a polypropylene mesh in a modified inlay position by using two peritoneal flaps prepared from the hernia sac in order to reinforce in the midline the anterior and posterior aspects of the abdominal rectus muscles. Intraabdominal pressure values recorded preoperatively and after the patient underwent anesthesia were within range. RESULTS: At the end of the intervention a slight pressure elevation was detected, but without exceeding 12 mmHg. The benefits of the procedure demonstrated to be tension free were as follows: quick resumption of bowel movements, absence of postoperative pain and improvement of respiratory parameters through reestablishment of the abdominal press after the reconstruction has been completed. CONCLUSIONS: Intraabdominal pressure monitoring is an objective method of assessing the tension free principle in abdominal wall reconstructions. Observing the tension free principle improves postoperative evolution and respiratory function. The use of the flaps prepared from the hernia sac allows a tension free closure and reconstruction of the abdominal wall.