title: Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia.
abstract: Combination of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BT) has not been previously reported in the management of large incisional hernia (LIH).
  
  
  
  Observational study of 45 consecutive patients with LIH between June 2010 and July 2014. The diameters of the hernia sac, the volumes of the incisional hernia (VIH) and the abdominal cavity (VAC), and the VIH/VAC ratio were measured before and after PPP and BT using abdominal CT scan data. We indicated the combination of both techniques when the volume of the incisional hernia (VIH)/volume of the abdominal cavity (VAC) ratio was >20%.
  
  
  
  The median insufflated volume of air for PPP was 8.600 ± 3.200 cc (4.500-13.250), over a period of 14.3 ± 1.3 days (13-16). BT administration time was 40.2 ± 3.3 days (37-44). We obtained an average value of reduction of 14% of the VIH/VAC ratio after PPP and BT (p < 0.05). Complications associated with PPP were 15.5%, and with surgical technique, 26.6%. No complications occurred during the BT administration. Reconstructive technique was anterior CST and primary fascial closure was achieved in all patients. Median follow-up was 40.5 ± 19 months (12-60) and we reported 2 cases of hernia recurrence (4.4%).
  
  
  
  Preoperative combination of PPP and BT is feasible and a useful tool in the surgical management of LIH, although at the cost of some specific complications.
authors.affiliation: Surgical Unit of Abdominall Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Avd. Fernando Abril Martorell 106, 46126, Valencia, Spain. buenolledo@hotmail.com.
authors.forename: J
authors.identifier: 0000-0002-3116-5022
authors.initials: J
authors.lastname: Bueno-Lledó
authors.affiliation: Surgical Unit of Abdominall Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Avd. Fernando Abril Martorell 106, 46126, Valencia, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Torregrosa
authors.affiliation: Surgical Unit of Abdominall Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Avd. Fernando Abril Martorell 106, 46126, Valencia, Spain.
authors.forename: N
authors.initials: N
authors.lastname: Ballester
authors.affiliation: Surgical Unit of Abdominall Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Avd. Fernando Abril Martorell 106, 46126, Valencia, Spain.
authors.forename: O
authors.initials: O
authors.lastname: Carreño
authors.affiliation: Department of Surgery, Instituto Valenciano de Oncología (IVO), Valencia, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Carbonell
authors.affiliation: Surgical Unit of Abdominall Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Avd. Fernando Abril Martorell 106, 46126, Valencia, Spain.
authors.forename: P G
authors.initials: PG
authors.lastname: Pastor
authors.affiliation: Department of Radiology, "La Fe" Universitary Hospital, Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Pamies
authors.affiliation: Department of Neurophysiology, "La Fe" Universitary Hospital, Valencia, Spain.
authors.forename: V
authors.initials: V
authors.lastname: Cortés
authors.affiliation: Surgical Unit of Abdominall Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Avd. Fernando Abril Martorell 106, 46126, Valencia, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Bonafé
authors.affiliation: Surgical Unit of Abdominall Wall, Department of Digestive Surgery, "La Fe" Universitary Hospital, University of Valencia, Avd. Fernando Abril Martorell 106, 46126, Valencia, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Iserte
mesh_terms: D000009:Abdominal Muscles / Q000187:drug effects; D000328:Adult; D000368:Aged; D000465:Algorithms; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D005240:Feasibility Studies; D005260:Female; D006555:Hernia, Ventral / Q000188:drug therapy / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D000069290:Incisional Hernia / Q000188:drug therapy / Q000601:surgery*; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D011028:Pneumoperitoneum, Artificial / Q000379:methods*; D011300:Preoperative Care; D013526:Surgical Mesh
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin A; Incisional hernia; Large incisional hernia; Preoperative progressive pneumoperitoneum; Ventral hernia