Editing Hernia (section)

== '''Loss of domain''' ==

* Not well-defined - 'a hernia sac of great size that forms a secondary abdominal cavity'; 'large enough that primary fascial closure either cannot be achieved without additional reconstructive techniques or significant risk of complications due to raised abdominal pressure'
** >20-50% of abdominal contents residing outside the abdomen
** One definition from Tanaka et al: '''when hernia volume greater than >25% of abdominal compartment volume (excluding hernia)'''
* Pathophysiology
** Abdominal contents no longer reside in the abdominal cavity, and therefore cannot simply be placed back inside
** Natural rigidity of abdominal wall becomes compromised and musculature retracts
** Complications:
*** MSK problems
*** Ventilatory dysfunction - cause paradoxical respiratory abdominal movement - compromised respiratory function
*** GIT dysfunction - can result in bowel oedema, stasis of the splanchnic venous system, urinary retention, and constipation
*** Psychosocial issues
* Management
** Patient needs to understand how big of an undertaking this is going to be
** Optimise everything medically - see separate topic under 'ventral incisional hernia'
** May need additional techniques for closure - see 'ventral incisional hernia'
*** Usually benefits from Botox and component separation
** Watch post-op for intra-abdominal hypertension