To explore the clinical application of initiative content reduction with Onlay surgery for the treatment of large incisional hernia and prevention its complications.

A retrospective study was conducted on 18 cases of large incisional hernia in Xinjiang Uygur Autonomous Region People's Hospital from January 2015 to June 2016, and all patients underwent preoperative MSCT to measure the volume of the hernia sac and the volume of abdominal cavity, the diameter of the hernia size. The initiative content reduction with Onlay surgery was performed according to the volume ratio. The operation time, blood loss, resection length, intravesical pressure, normal activity time, duration in hospital time, complications and recurrence rate were observed.

The mean operation time was (2.1±0.8) hours; the resection length was (49.4±15) cm; blood loss was (82±30.1) ml. The intravesical pressure showed that there were 3 cases (3/18) of IAH Grade Ⅰ, 1 case (1/18) of IAH Grade Ⅱ, none of ACS during perioperative period (IAH Ⅲ, IAH Ⅳ), no deaths. There were 2 cases of incision effusion and 1 case of incisional infection, improved after symptomatic treatment, no delayed infection. After 8 to 24 months of follow-up, one patient had recurrence without re-operation.

Initiative content reduction combined with Onlay surgery is safe and feasible to prevent the complications associated with intra-abdominal pressure of large incisional hernia repair, worthy spreading and need to further study.