A Preoperative Algorithm for Loss of Domain Hernia Repair: Stratified Management Using the Tanaka Index in 50 Cases

Area of Science:

• Abdominal Wall Reconstruction
• Surgical Innovation
• Hernia Repair

Background:

• Loss of domain (LOD) in incisional hernias complicates abdominal wall reconstruction.
• Preoperative optimization is vital to prevent abdominal compartment syndrome (ACS).
• The Tanaka Index (TI) quantifies domain loss severity.

Purpose of the Study:

• To develop a patient selection algorithm for preoperative strategies in LOD hernias.
• To tailor interventions based on the Tanaka Index severity.
• To optimize surgical outcomes and minimize ACS risk.

Main Methods:

• Prospective study of 50 LOD hernia cases (TI > 0.25) from 2021-2024.
• Component separation using Transversus Abdominis Release (TAR) with varying peritoneal flap reinforcement based on TI.
• Preoperative protocol (botulinum toxin, progressive pneumoperitoneum) for TI > 0.35 cases.
• Intraoperative airway pressure and postoperative intra-abdominal pressure monitoring.

Main Results:

• Algorithm successfully managed 50 LOD hernia cases.
• Only two patients experienced transient elevated intra-abdominal pressures postoperatively.
• Low rates of surgical site infections (6%) and no recurrences at 1-year follow-up.

Conclusions:

• A structured algorithm effectively manages LOD hernias by tailoring preoperative preparation.
• Minimizes ACS risk through integrated monitoring.
• Optimizes fascial closure, reduces morbidity, and ensures favorable long-term outcomes.