Application of preoperative progressive pneumoperitoneum in treating complex incisional hernia repair

doi:10.3877/cma.j.issn.1674-0793.2018.04.011

Abstract

Abstract:

Objective

To analyze the efficacy and safety in the treatment of patients with progressive pneumoperitoneum (PPP) prior to elective repair of the complex incisional hernia.

Methods

This retrospective study assessed twenty-one patients between January 2015 and February 2017 with complex incisional hernias. All patients underwent serial computed tomography of the abdomen with volume measurements of the peritoneal cavity and hernia sac before and after pneumoperitoneum.

Results

Twenty-one patients successfully completed the pneumoperitoneum. The mean overall duration of pneumoperitoneum was (16.6±1.8) days, the mean insufflated volume of air was (3.7±0.9) L; 4 patients (19.0%) suffered from pneumoperitoneum-related complications, consisting of one subcutaneous emphysema and three of scapular pain. Before and after PPP, the mean volume of the incisional hernia (VIH) was (901.0±430.8) ml, (1 115.1±481.9) ml, the mean volume of the abdominal cavity (VAbC) was (6 741.9±1 746.9) ml, (8 962.3±2 272.9) ml, VIH/(VIH+VAbC)×100% was (12±5)% and (11±4)%, the differences were statistically significant (t=11.3, 12.4, 2.9, all P<0.01). The mean gain in volume of the hernia sac was 214 ml (26.0%) and the abdominal cavity was 2 220 ml (33.7%) after PPP. Most patients showed spontaneous reduction of the hernia contents. The operations of all patients were successful, no bowel injury was found, the mean operative time and postoperative length of stay were (180.1±50.6) min, (11.4±9.0) d. Complete closure of the abdominal wall defect was performed in all patients. Postoperatively, there were 2 cases of seroma, 1 case of dyspnea, 1 case of pneumonia, all patients were better after symptomatic treatment. There were no patients experiencing abdominal hypertension and cardiorespiratory failure postoperatively. After a mean follow-up of (13.0±8.0) months, there were no hernia recurrences.

Conclusions

PPP is a useful adjunct in complex ventral hernia repair, allowing the reintroduction of herniated content into the abdominal cavity. Simultaneously, pneumoperitoneum has an acceptable overall morbidity.

Key words: Pneumoperitoneum, artificial, Hernia, abdominal, Defect,abdominal wall, Herniorrhaphy

Fuxin Tang, Shuang Chen. Application of preoperative progressive pneumoperitoneum in treating complex incisional hernia repair[J]. Chinese Archives of General Surgery(Electronic Edition), 2018, 12(04): 260-264.

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Figures/Tables 7

References 21

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