Loss of domain (LOD) is a term used in hernia literature to describe the ratio of peritoneal content located in the hernia sac. The LOD ratio expresses the relationship between the hernia and the residual abdominopelvic cavity and it is used by surgeons to predict the risk of pre, post, and perioperative complications in hernia operations.
Here is a simplified breakdown of the Loss of domain (LOD) ratio:
The type and amount of abdominal contents found in a hernia sack will vary from patient to patient. Regardless of the contents, low loss of domain means that the hernia sac contains a relatively small proportion of the abdominal contents. Such hernia sacs are easier to operate on.
Conversely, if the loss of domain is higher than 20%, there’s a major risk of surgical complications. In other words, if surgeons do not calculate a hernia patient’s loss of domain (LOD) ratio, they expose themselves to high risks of surgical complications.
So, how do surgeons calculate the LOD ratio? By dividing the Hernia Sac Volume (HSV) by the Total Peritoneal Volume (TPV):
Performing surgery on hernia patients with high LOD is not easy. Before operating on such patients, surgeons have to account for countless technical difficulties and risks of post-operative complications. Calculating the LOD ratio is the only way surgeons can accurately plan for these risks. The LOD ratio also helps surgeons:
In summary, evaluating the loss of domain (LOD) ratio in patients with complex ventral hernias is the most effective way for hernia surgeons to guarantee better outcomes for their patients. Hopefully, this guide has been helpful in simplifying this critical yet confusing concept in modern-day hernia care!
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