ORIGINAL ARTICLE Anterior Component Separation Technique Is Efficient Enough in Loss of Domain Hernia Treatment Salih Tosun 1 & Nesrin Gunduz 2 Received: 1 June 2019 /Accepted: 24 March 2020 # Association of Surgeons of India 2020 Abstract Repair of loss of domain hernia (LODH) has many related postoperative complications and abdominal separation techniques are well-accepted methods for avoiding abdominal compartment syndrome. The purpose of our study was to evaluate the effective- ness of anterior component separation technique and method of the patient selection for this technique in LODH. Between 2016 and 2019, 40 consecutive patients operated for LODH with over 10-cm fascial defect were analyzed prospectively. Patients were divided into two groups according to the hernia volume/abdominal volume ratio. Group 1 included patients less than 0.25 ratio and group 2 over 0.25. Bladder pressure, length of hospital stay, pain, bleeding, wound infection, and the duration of drainage tube were compared between groups. Average operation time, hospital stay, and wound drainage time was similar in both groups. In group 1, postoperative intra-abdominal hypertension was detected in 5 patients, whereas there was none in group 2. The rating of the individual measurement and sum of the defects will give proper results in multiple hernia defects. The properly performed anterior component separation alone would be an effective method on patients with LODH in order to avoid abdominal compartment syndrome. Keywords Component separation . Hernia volume . Facial relaxation . Bladder pressure . Abdominal compartment Introduction The treatment loss of domain hernia (LODH) is a difficult situation for surgeons and has many related postoperative complications, including abdominal compartment syndrome (ACS) [1]. The difficulty of the treatment, as well as high rates of recurrence after surgical treatment, is a challenging factor for the surgeons [2–6]. Diabetes, male sex, advanced age, obesity, incision type, immune suppression therapy, wound infection, and pulmonary comorbidities are the most prevalent risk factors for incisional hernia treatment. [2, 3, 7–9]. Surgery of the LODH can result in a morbidity of 10–15% and mortality of 1–2%. Chronic muscle retraction reduces the volume of the peritoneal cavity and makes the fascial closure having potential problems such as ACS, ventilatory restric- tion, and an elevated risk of hernia recurrence [10, 11]. Incisional hernia can be classified by considering location, width, recurrence, situation at the hernia defect, and symp- toms. LODH is a term used commonly in literature to describe the distribution of abdominal content between the hernia and residual abdomino-pelvic cavity. After repairing large hernias with significant LOD that contains the abdominal viscera out- side the abdominal compartment, serious physiological com- plications can arise [12]. Incisional hernias over 10-cm width are called large hernias [13]. They are large hernias containing large volumes of abdominal viscera [12]. Although LODH would be more prevalent in hernias over 10-cm width, not every large incisional hernia would have loss of domain, as LODH was not being utilized in any standardized fashion. Due to the difficulty of defining the pathology and the complexity of proposing a standardized surgical approach to this clinical condition, Tanaka described the formula of incisional hernia sac volume (VIH)/abdominal cavity volume (VAC) with CT evaluation. He used this technique for all patients with large incisional hernias over 10-cm width with suspected LODH. If the ratio was more than 0.25, he used * Salih Tosun drsalihtosun@yahoo.com 1 Department of General Surgery, Dumlupinar Mahallesi, Istanbul Medeniyet University, D-100 Karayolu No:98, Kadikoy, 34000 Istanbul, Turkey 2 Department of Radiology, Istanbul Medeniyet University, Istanbul, Turkey Indian Journal of Surgery https://doi.org/10.1007/s12262-020-02151-9