Preoperative Progressive Pneumoperitoneum Revisited (original) (raw)
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Chirurgia (Bucharest, Romania : 1990)
forced repair of a giant abdominal wall defect end with unsatisfactory results despite development of prosthetics materials. The enlargement of abdominal wall dimensions could be realized altogether other methods with the aid of pneumo-peritoneum. The aim of the study is to evaluate early results of the method used for patients with giant incisional hernias. between june 1998 - june 2013, 17 patients (4 males) with giant abdominal wall defects (incisional and inguinal hernias) were prepaired for radical surgery with pneumoperitoneum. Average age was 64.35 years. We reevaluated the standard constants of the pulmonary function,blood gases, and intra-vesical pressure in 3 moments: before the first gas insuflation, 24 hours before surgery and in the 7th daypost operatively. the method was free of accidents or incidents, no mortality was recorded. The respiratory function was significantly increased and also the intra-abdominal pressure. our results suggest that the method of progressive...
Surgical Endoscopy, 2016
Background A rarely used technique for enabling closure of large ventral hernias with loss of domain is preoperative progressive pneumoperitoneum (PPP), which uses intermittent insufflation to gradually stretch the contracted abdominal wall muscles, increasing the capacity of the abdominal cavity. This allows the re-introduction of herniated viscera into the abdominal cavity and assists in closure of giant hernias which may otherwise be considered inoperable. Methods This was a prospective study assessing 16 patients between 2013 and 2015 with multi-recurrent ventral hernia. All patients were treated preoperatively with both Botulinum Toxin A (BTA) injections to the lateral abdominal wall muscles to confer flaccid paralysis, and short-term PPP to passively expand the abdominal cavity. All patients underwent serial abdominal CT imaging, with pre-and post-treatment circumference measurements of the peritoneal cavity and hernia sac, prior to undergoing operative mesh repair of their hernia. Results The mean hernia defect size was 236 cm 2 , with mean 28 % loss of domain. The mean overall duration of PPP was 6.2 days. The mean gain in abdominal circumference was 4.9 cm (5.6 %) (p 0.002) after BTA and PPP. Fascial closure and mesh hernia repair were performed in all 16 patients, with no patients suffering from postoperative abdominal hypertension, ventilatory impairment, or wound dehiscence. There are no hernia recurrences to date. Eight patients (50 %) experienced PPP-related complications, consisting of subcutaneous emphysema, pneumothorax, pneumomediastinum, pneumocardium, and metabolic acidosis. No complication required intervention. Conclusions PPP is a useful adjunct in the repair of complex ventral hernia. It passively expands the abdominal cavity, allowing viscera to re-establish right of domain. At the same time, it helps to minimize the risks of postoperative abdominal compartment syndrome and the sequelae of fascial closure under tension. However, its benefits must be carefully weighed with the risk of serious complications, such as infection, perforation, pneumothorax, and pneumomediastinum. Keywords Preoperative progressive pneumoperitoneum Á Botulinum toxin A Á Complex ventral hernia Á Incisional hernia Á Loss of domain
Progressive Preoperative Pneumoperitoneum in Patients With Giant Hernias of the Abdominal Wall
Cirugía Española (English Edition), 2013
Introduction: Patients with giant hernias with loss of domain require proper planning of surgical repair, because of the high associated comorbidity. The progressive preoperative pneumoperitoneum technique described by Goñ i Moreno allows a more physiological adaptation of the patient and the abdominal cavity to the reinstatement of the viscera to the abdomen, enabling adequate surgical repair. The objective of this study was to analyze our experience in the treatment of this type of hernia. Materials and methods: We carried out a retrospective study that included 11 patients with major abdominal wall defects and loss of domain who were treated with this technique in 2 centers between 2005 and 2010. Results: Eight patients had abdominal hernias and 3 had inguinal hernias. The average insufflation time was 2 weeks and the total amount of air was between 6.6 and 18 l. In 2 patients who showed pulmonary disease decompensation, insufflation had to be temporarily postponed. A further 2 patients had subcutaneous emphysema during the last few days of insufflation, which resolved spontaneously without sequelae. The open mesh repair technique was used in ventral hernias and the preperitoneal technique in all inguinal hernias. There was one recurrence during the 1-year follow-up. Conclusions: Goñ i Moreno's technique remains safe to prepare patients with giant hernias with loss of domain. This procedure can reduce the morbidity caused by the increase in abdominal pressure after abdominal wall repair.
American Journal of Medicine and Surgery, 2023
Obesity is an important risk factor for development of hernias on the anterior abdominal wall1 Incisional Abdominal wall hernias have been appearing at 13% secondary to laparotomies.2 However, some types of hernias require advanced and challenging pre or perioperative management, particularly in the case of giant hernias or a hernia associated with loss of domain.3-4 Challenges for the specialized surgeons are multiple. They must assure a successful tension-free closure of the fascial defect. Also to prevent surgically abdominal compartment syndrome caused for induced quickly the visceras and finally avoid recurrence of the hernia . 5-6 Early preoperative progressive pneumoperitoneum (PPP) is a technique that helps in big eventrations with loss of domain to reintroduce protruded organs. PPP is a technique that pursues the prevention of abdominal hypertension syndrome. PPP acts as a pneumatic tissue expander. 7 A muldisciplinary team can improve decision making and therefore reduce the risk of a long-term complication. We show a case where PPP was performed in no acute painful, reducible with high risk of incarceration, morbid obesity with high risk to infection and complications, showing the benefic of PPP in our patient.
International Surgery Journal
Managing a giant inguinal hernia/ incisional/ ventral hernia had its own complications. The overtime adaptation of peritoneal cavity to a lower abdominal pressure was one of the most important factors responsible for these complications. Surgical repair is also quite a challenge because of the massive contents in sac, adhesions and concomitant fibrosis. In order to reduce the complications like intra-abdominal hypertension, cardiorespiratory problems and to increase the abdominal wall compliance, many techniques were described. Progressive preoperative pneumoperitoneum is a well described technique for the repair of giant inguinal hernia/ incisional/ ventral hernia with loss of domain which helps in conditioning the abdominal wall in the preoperative period, increasing the likelihood of primary closure and decreasing the incidence of compartment syndrome.
COMPLEX INCISIONAL HERNIAS - CASE REPORT TREATED BY PERFORMING PRE-OPERATIVE PROGRESSIVE PNEUMOPERITONEUM (Atena Editora), 2023
Despite the increase in the number of minimally invasive surgeries, with a consequent reduction in incisional hernias, laparotomies and accessory incisions to remove parts maintain a high rate of incisional hernias, ranging between 15 and 20%. In this context, as a result of better surgical results and survival of patients with extensive oncological resections, abdominal vascular diseases and severe traumas, we see patients developing complex hernias Among the criteria chosen to identify a hernia as complex, loss of home is one of the most frequent Omar Rodriguez-Acevedo 2017. For the treatment of these large hernias, the progressive preoperative pneumoperitoneum (PPP) technique described by Goni Moreno in 1940 can be very useful, better preparing the patient to receive the contents of the hernia back into the abdominal cavity, minimizing the chance of developing intra-abdominal hypertension.
2020
Incisional hernias with loss domain (HIPD), has a prevalence between 5 - 20%, due to its technical complexity are a challenge for abdominal wall surgeon, because decrease in abdominal compliance, for muscle atrophy and retraction, as well as complications associated with the procedure. We present the preoperative use of progressive pneumoperitoneum (NPP), as a technique for preparing the abdominal wall, by placing a multipurpose permanent catheter (pig tail type) guided by computed tomography, for a 69-year-old male patient, farmer, and colostomy carrier. by sigma volvulus, which presented abdominal sepsis secondary to anastomosis dehiscence, which led to a colostomy, and HIPD formation of 25 x 15 cm. The benefits of NPP are: it reduces the size of the second cavity formed, facilitates the placement of the mesh, reduces the tension in the closure of the abdominal wall and the development of intra-abdominal hypertension syndrome, therefore a lower probability of post-surgical recurre...