Loss of Domain

 

Dr. Pramod Shinde 
M.S, FMAS, FIAGES, FALS

Is the chief Laparoscopic, GI, Bariatric and Onco surgeon. After having Done his MS in Surgery from Miraj Medical College and the famous Wanless Hospital from Miraj, he Started his Practice at Nashik in 1987. He is trained in Cancer, GI, Vascular and Portal Hypertension, Best hernia treatment, Fistula Treatment, Epigasric\colorectal treatment in Nashik.

Definition. there’s no normal definition for loss of domain, usually speaking it refers to the clinical scenario one additional of the viscus is outside the bodily cavity than within. Here more than 25% of abdominal contents are lying outside the Abdomen but are within the hernia cavity
In patients with LOD hernias, the bodily cavity is unable to totally accommodate the abdominal contents at intervals its fascial boundaries. Closure of the connective tissue is either not possible, or will result in high intra-abdominal pressures, fascial organic phenomenon, or abdominal compartment syndrome.


Symptoms
Loss of domain could have vital effects on the patient’s quality of life together with long-run incapacity, loss of core muscles, changes in spine curvature with back pain, incomprehensible metabolic process motion, peritoneumhydrops, poor internal organ operate, and cosmetic problems.
Patient management
Surgical treatment shouldn’t be offered if the experience is lacking, patient comorbidities area unit vital or if its unlikely to supply Associate in Nursing improvement in the quality of life. Patient choice involves careful assessment of medical standing together with age, BMI, reserve, poorly controlled diabetes, current smoking, and steroid use.
The goals of the repair involve tries at medializing the musculus, avoiding physiological compromise of the patient and reconstruction victimization mesh. Often, Associate in Nursing abdominal binder with the set up for a nonoperative strategy is that the best choice.
Preop coming up with
Some patients with loss of domain are often known preoperatively through imaging studies, establishing the degree of eviscerated contents and also the size of the bodily cavity. Some CT programs will calculate the volume of the bodily cavity and also the volume of herniated abdominal contents. choices embrace laparoscopic ventral herniation repair, surgical pneumoperitoneum, surgical tissue expanders, and open retrorectus repair. Patient risks issue modification together with smoking halt and weight loss got to be highlighted.

Preoperative Pneumoperitoneum
Preoperative pneumoperitoneum could also be achieved by inserting a tube intraperitoneal with a port within the connective tissue position. close air is often injected every few days. instead of a select a certain quantity of air to inject, it’s been recommended that insufflations be performed till the patient complaints of some gentle discomfort. The pneumoperitoneum doesn’t decrease he herniation defect, however, will give extra intraperitoneal area at a little take a look at of the patient’s respiratory organ reserves. Following this, the patient’s herniation often approached.

Surgical Repair
Open repair is often applicable|the acceptable|the suitable choice with elements separation additional to the repair inappropriate things. tries could also be created at musculus medialization and a retrorectus mesh placement. within the clean scenario, the artificial mesh is often used and within the contaminated scenario, the biological mesh could also be an applicable alternative.

Laparoscopic Repair
Loss of domain has historically been a reason for the laparoscopic approach. paroscopic repair in these things are

often technically troublesome, thanks to the cut operating area once the viscus is reduced. Techniques that may be helpful area unit addition of elements separation and dealing on top of the mesh to attain fixation. operating on top of the mesh are often technically difficult yet, with the required safeguarding that tacks don’t seem to be placed into internal organ attempting to sneak on top of the mesh. Outcomes from this method highlight the complications that replicate the troublesome patient population. (Continue Reading…)