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. Results: The mean age was 53 years, with a female preponderance (62%). Mean IAP rose from18.64 cmH₂O preoperatively to 21.77 cmH₂O upon awakening, 21.37 cmH₂O at 24 hours, and 21.77 cmH₂O at 48 hours.IAP increased postoperatively in 34/50 patients (68%). A progressive rise in mean IAP was observed with increasing BMI(13.0 cmH₂O for BMI <18.5 to 27.5 cmH₂O for BMI 30–34.9), increasing defect size (16.33 cmH₂O for 100–109 mm to34.5 cmH₂O for 190–200 mm), and increasing loss of domain (18.63 cmH₂O for <15% to 26.83 cmH₂O for >25%). Sevenpatients (14%) developed Grade 3 IAH; none progressed to overt ACS requiring decompression. Conclusion: IntravesicalIAP monitoring is a simple, inexpensive, and reproducible bedside tool that reliably identifies patients at risk of IAH/ACSafter large ventral hernia repair. Larger defect size, higher BMI, and greater loss of domain are associated with greaterpostoperative pressure elevation and should guide perioperative risk stratification and surgical planning, includingconsideration of posterior component separation with transversus abdominis release in high-risk patients.