Role of intra-abdominal pressure measurement in the perioperative management of large and complex ventral hernia repair: A prospective observational study

Background

Large and complex ventral hernias are frequently associated with loss of domain, and reduction of herniatedviscera during repair can precipitate a clinically significant rise in intra-abdominal pressure (IAP), predisposing to intraabdominalhypertension (IAH) and abdominal compartment syndrome (ACS). Serial perioperative IAP monitoring mayallow early identification of patients at risk. The objective is to evaluate perioperative IAP in patients undergoinglarge/complex ventral hernia repair and to correlate pressure changes with body mass index (BMI), abdominal wall defectsize, and loss of domain (Tanaka index). Materials and Methods: This prospective observational study enrolled 50 adultpatients undergoing elective repair of large/complex ventral hernias (abdominal wall defect ≥10 cm) at a tertiary care centrebetween February 2024 and April 2026. IAP was measured by the indirect intravesical (bladder) technique preoperatively,upon awakening, and at 24 and 48 hours postoperatively. Associations between IAP and BMI, defect size, and loss ofdomain were analysed.