Relation between Techniques of Surgical Repair, Intra-operative Peak Airway Pressure Changes and Post-operative Chest Infection in Patients Undergoing Surgical Repair of Large Anterior Abdominal Wall Hernias under General Anaesthesia

Background: Large anterior abdominal wall hernia repair is hampered by possible respiratory complications. Higher Peak airway pressure relates to post-operative chest infections.Aim: To determine association between intra-operative Ppeak changes according to surgical technique used and post-operative chest infections in large anterior abdominal wall hernias repair.Methods: Thirty adult patients had general anaesthesia for repair of large anterior abdominal wall hernias involving defect closure then mesh application. Plication before mesh was performed selectively based on abdominal wall strength and respiratory capacity, while component separation was considered case by case.Results: The mean age was 62.87 ± 4.62 years, and 70% were females. The mean BMI was 26.73 ± 5.52 kg/m2. The mean hernia defect was 10.32 ± 1.24 cm, the mean operation duration of 125.23 ± 33.83 minutes, The Ppeak was 17.18 ± 4.3 cm H2O. Operative measurements showed increased airway pressure and partial pressure of carbon dioxide along with significant changes in arterial lactate levels and dynamic compliance. The mean in-hospital stay was 4.57 ± 1.83 days. Longer operation duration (126.88 ± 35.17 minutes), larger mean hernia defect (11.48 ± 1.44 cm), and higher Ppeak (19.5 cm H2O) are related.A significant association (r = 0.321, p = 0.040) was observed between Ppeak and post-operative chest infection.Conclusion: This study highlights impact of surgical techniques on Ppeak and post-operative complications in large anterior abdominal wall hernia. Higher Ppeak was associated with increased post-operative chest infections. Patients with longer operative times and larger hernia defects had a higher risk of respiratory complications. Despite stable arterial blood gas values, dynamic lung compliance declined post-surgery, indicating potential respiratory impairment. A careful intra-operative Ppeak management is needed to minimize post-operative respiratory infections and optimize outcomes.