Insufflation Effects on the Abdominal Wall Dimensions and Incisional-Ventral Hernia Orifice Size

The possibility that ventral hernia orifice size may increase with insufflation at the time of laparoscopic ventral hernia repair has a number of consequences, including mesh size used and trocar placement. We measured ventral hernia orifice defects intraoperatively at 8 mm Hg and 15 mm Hg for comparison. We also took measurements of the external abdominal wall at various points to determine the relationship between insufflation and the abdominal wall externally. Of 39 patients measured, we found a mean increase of 3.7 mm in the hernia defect transversely and 2.9 mm vertically. The external measurements showed correlation with insufflation pressure, as expected. The transverse measurements across the mid-abdomen showed a mean increase of 5 mm from 0 to 8 mm Hg insufflation and a full additional centimeter when insufflation was increased from 8 to 15 mm Hg. We were able to detect and quantify an increase in hernia defect size with insufflation, but the increase is so small it is unlikely to be clinically significant in the management of surgical patients.