title: [Preoperative progressive pneumoperitoneum in voluminous abdominal wall hernias].
abstract: BACKGROUND
  Correction of voluminous hernias and large abdominal wall defects is a big challenge in surgical practice due to technical difficulties and the high incidence of respiratory and cardiovascular complications.
  
  
  OBJECTIVE
  To present the authors experience with inducing progressive pneumoperitoneum preoperative to surgical treatment of voluminous hernias of the abdominal wall.
  
  
  METHODS
  Retrospective study of six patients who presented voluminous hernias of the abdominal wall and were operated after installation of a pneumoperitoneum. The procedure was performed by placing a catheter in the abdominal cavity at the level of the left hypochondrium with ambient air insufflation for 10 to 15 days.
  
  
  RESULTS
  Four of the six patients were female and two male. Ages ranged from 42 to 62 years. Hernia duration varied from 5 to 40 years. Four patients had incisional, one umbilical, and one inguinal hernias. Mean pneumoperitoneum time was 11.6 days. There were no complications related to pneumoperitoneum installation and maintenance. All hernias were corrected without technical difficulties. The Lichtenstein technique was used to correct the inguinal hernia, peritoneal aponeurotic transposition for one of the incisional hernias, with the rest corrected using polypropylene mesh. One death and one wall infection were observed post operatively. No recurrences were reported until now, in 4 to 36 months of follow-up.
  
  
  CONCLUSIONS
  Preoperative progressive pneumoperitoneum is a safe and easy executed procedure, which simplifies surgery and reduces post-operative respiratory and cardiovascular complications. It is indicated for patients with hernias that have lost the right of domain in the abdominal cavity.
authors: Departamento de Cirurgia e Ortopedia, Disciplina de Gastroenterologia Cirúrgica da Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu, SP, Brazil. jminossi@uol.com.br
authors: José Guilherme
authors: JG
authors: Minossi
authors: Walmar Kerche de
authors: WK
authors: Oliveira
authors: Juan Carlos
authors: JC
authors: Llanos
authors: Samuel Moraes
authors: SM
authors: Ielo
authors: Claudia Nishida
authors: CN
authors: Hasimoto
authors: Rodrigo Severo de Camargo
authors: RS
authors: Pereira
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D046449:Hernia, Abdominal / Q000473:pathology / Q000601:surgery*; D006555:Hernia, Ventral / Q000473:pathology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011028:Pneumoperitoneum, Artificial / Q000009:adverse effects / Q000379:methods*; D011300:Preoperative Care; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome