A treatment protocol for giant ventral hernias based on predicted postoperative respiratory function

Giant ventral hernias and loss-of-domain abdominal wall defects remain challenging because reintegration of hernia contents may increase intra-abdominal pressure and impair postoperative respiratory function.

We describe a structured institutional protocol that integrates abdominopelvic CT volumetry, the hernia sac/abdominal cavity volume ratio, respiratory function testing during progressive simulated abdominal occupation, preoperative botulinum toxin, progressive pneumoperitoneum, transversus abdominis release and, only in selected high-risk cases, volume transposition.

The protocol is intended to support individualized surgical planning by estimating both abdominal and respiratory consequences before definitive reconstruction.

This manuscript should be interpreted as a methodological protocol and feasibility proposal rather than a validated predictive clinical model. Prospective validation with standardized endpoints is ongoing and will be required before the thresholds can be considered externally validated.