Physiological Challenges in Abdominal Wall Reconstruction

Complex abdominal wall reconstruction abruptly challenges physiological adaptations that have developed over years. Returning viscera to the abdominal cavity and closing the fascia can increase intra-abdominal pressure, alter diaphragmatic position and chest-wall loading, and compromise respiratory function. From an anaesthesiological perspective, anatomical closure therefore raises a fundamental question: can this patient physiologically tolerate the reconstruction? Intra-abdominal pressure alone cannot answer it, because pressure transmission and respiratory responses vary between patients. Plateau pressure, driving pressure and respiratory-system compliance describe the mechanical response in related ways, but must be interpreted in relation to ventilation, lung recruitment and chest-wall mechanics. Existing evidence links perioperative changes to respiratory complications, yet provides no validated threshold for altering fascial closure. Bringing together anaesthesiology, intensive care and abdominal wall surgery is essential to connect preoperative assessment, intraoperative physiology and postoperative recovery, and to define the evidence needed for individualised reconstruction.

This Special Issue will examine physiological tolerance to abdominal wall reconstruction primarily from the perspective of perioperative anaesthesiology. It aims to clarify how respiratory mechanics and intra-abdominal pressure can be measured and interpreted alongside haemodynamics, oxygenation and clinical assessment. A central objective is to distinguish established observations from unvalidated decision tools: associations with complications do not establish safe closure thresholds, and improved ventilation during surgery does not guarantee successful extubation. Contributions should examine monitoring during fascial approximation, while closure can still be modified, as well as preoperative optimisation, postoperative ventilation and recognition of organ dysfunction. By linking anaesthesiologists, intensivists and surgeons, the collection will define research priorities for prospective studies of physiological endpoints and joint clinical decisions, including whether acting on measured physiological changes improves patient outcomes.

We welcome focused reviews, original research and opinion articles addressing three connected themes: respiratory mechanics as potential physiological endpoints during complex reconstruction; intra-abdominal hypertension and abdominal compartment syndrome after reconstruction, including the proposed quaternary phenotype; and prediction of tolerance to fascial closure in loss-of-domain hernias. Topics include plateau and driving pressures, respiratory-system and abdominal compliance, standardised pressure monitoring, perioperative ventilation, recruitment and individualised PEEP, extubation planning and postoperative surveillance. Preoperative contributions may examine CT volumetry, respiratory assessment, botulinum toxin, progressive pneumoperitoneum and optimisation in relation to physiological reserve. We encourage studies distinguishing pulmonary from chest-wall loading, integrating anaesthetic monitoring with surgical decisions, and testing reproducible protocols and clinical outcomes. Perspectives should identify research priorities without presenting exploratory thresholds or monitoring strategies as established standards.

Article types and fees

This Special Issue accepts the following article types, unless otherwise specified in the Special Issue description:

• Brief Research Report
• Case Report
• Commentary
• Editorial
• In Memoriam
• Letter to the Editor
• Mini Review
• Opinion
• Original Research
• ... View all formats

Articles that are accepted for publication by our external editors following rigorous peer review incur a publishing fee charged to Authors, institutions, or funders.

Article types

This Special Issue accepts the following article types, unless otherwise specified in the Special Issue description:

• Brief Research Report
• Case Report
• Commentary
• Editorial
• In Memoriam
• Letter to the Editor
• Mini Review
• Opinion
• Original Research
• Protocol
• Review

Keywords: Anaesthesiology, abdominal wall reconstruction, respiratory mechanics, intra-abdominal hypertension, abdominal compartment syndrome, physiological tolerance, loss of domain, perioperative monitoring