title: Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study.
abstract: BACKGROUND
  Progressive preoperative pneumoperitoneum (PPP) is used to prepare incisional hernias with loss of domain (IHLD) operations. The aim of the present study was to analyze the effect of PPP on peritoneal volume [measured using a new computed tomography (CT)-based method] and respiratory function.
  
  
  METHODS
  From July 2004 to July 2008, 19 patients were included in a prospective, observational study. The volumes of the incisional hernia (VIH), the abdominal cavity (VAC), the total peritoneal content (VP) and the VIH/VP ratio were measured before and after PPP using abdominal CT scan data. Spirometric parameters were measured before and after PPP, and postoperative clinical data were evaluated.
  
  
  RESULTS
  Before and after PPP, the mean VIH was 1,420 cc and 2,110 cc (P  < 0.01), and the mean VAC was 9,083 cc and 11,104 cc (P < 0.01). The VAC increased by 2,021 cc (P < 0.01) and was greater than the mean VIH before PPP. After PPP, the spirometric measurements revealed a restrictive syndrome. The overall postoperative morbidity rate was 37%.
  
  
  CONCLUSIONS
  PPP increased the hernia and abdominal volumes. PPP induced a progressive, restrictive syndrome.
authors.affiliation: Department of Digestive Surgery, Amiens University Medical Center, Place Victor Pauchet, 80054 Amiens Cedex 01, France.
authors.forename: C
authors.initials: C
authors.lastname: Sabbagh
authors.forename: F
authors.initials: F
authors.lastname: Dumont
authors.forename: D
authors.initials: D
authors.lastname: Fuks
authors.forename: T
authors.initials: T
authors.lastname: Yzet
authors.forename: P
authors.initials: P
authors.lastname: Verhaeghe
authors.forename: J-M
authors.initials: JM
authors.lastname: Regimbeau
mesh_terms: D034841:Abdominal Cavity / Q000000981:diagnostic imaging / Q000473:pathology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005540:Forced Expiratory Flow Rates; D005541:Forced Expiratory Volume; D046449:Hernia, Abdominal / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011446:Prospective Studies; D012115:Residual Volume; D013147:Spirometry; D014057:Tomography, X-Ray Computed; D014781:Viscera / Q000000981:diagnostic imaging / Q000473:pathology*; D014797:Vital Capacity