Quaternary abdominal compartment syndrome in complex ventral hernias

Abstract

PURPOSE: Abdominal wall reconstruction (AWR) can lead to raised intra-abdominal pressure (IAP) in the postoperative setting. The term “quaternary abdominal compartment syndrome” (QACS) was recently proposed as an abdominal compartment syndrome in the particular setting of AWR that reverts with medical treatment. The aim of this report is to determine the incidence of QACS in our series, potential risk factors and the outcome of these patients. METHODS: A retrospective study was conducted between 2010 and 2019 at our hospital, to identify patients with QACS after AWR and respective risk factors. RESULTS: From a total of 115 patients, five were diagnosed with QACS, all being hernias with Loss of Domain (LOD) ≥20% and showing major renal and pulmonary impairment. Four patients had predictable transitory QACS, yet one patient died despite damage control surgery. A total of 19 patients had LOD ≥20%, 14 without QACS development and 5 with this entity. The most important finding between the groups was a significant variation in the Peak Respiratory Pressure (PRP) (measured before incision and intraoperatively), being higher in the QACS group (7.40 ± 1.34 vs. 3.77 ± 1.59; P < 0.001). CONCLUSION: In this study, QACS was found to be a rare event, not always transitory. LOD ≥20% appeared as an important risk factor and PRP variations between 6 and 10 mmHg during fascial closure were a significant marker for adverse endpoints in AWR.

Keywords

• abdominal wall reconstruction
• complex ventral hernia
• intraabdominal hypertension
• loss of domain
• primary fascial closure
• quaternary abdominal compartment syndrome
• ventral hernia repair