[Preoperative progressive pneumoperitoneum in voluminous abdominal wall hernias].
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.
Minossi
José Guilherme
JG
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
Oliveira
Walmar Kerche de
WK
Llanos
Juan Carlos
JC
Ielo
Samuel Moraes
SM
Hasimoto
Claudia Nishida
CN
Pereira
Rodrigo Severo de Camargo
RS
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