A systematic review of the use of progressive preoperative pneumoperitoneum since its inception

Martínez-Hoed, Jesús; Bonafé-Diana, S; Bueno-Lledó, José

doi:10.1007/s10029-020-02247-x

Cited by 44 publications

(25 citation statements)

References 54 publications

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“…The 2017 publication reported a significant correlation between hernial width and the need for bridging. The current study found no significant variation (median width without bridging 12.5 (12-16) cm, with bridging 14 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22) cm, p = .48). The median length gain on the lateral abdominal wall (decrease in defect width) after 30 min of fascial stretching was 12 (10-15) cm.…”

Section: Procedures Characteristicscontrasting

confidence: 71%

“…[11][12][13] Progressive pneumoperitoneum has also been used for gradual stretching of the abdominal wall muscles. [14][15][16][17][18][19][20][21] After inserting a peritoneal catheter, air is insufflated into the abdominal cavity under low pressure for up to 14 days to stretch the contracted muscles. The limited efficiency of this method has precluded widespread use although it has been reported for decades.…”

Section: Principlesmentioning

confidence: 99%

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Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study

et al. 2021

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Background The abdominal wall expanding system (AWEX) was first applied in 2012 and published in 2017. This novel technique was developed to reconstruct complex incisional hernias and residual skin-grafted laparostoma after treatment of an open abdomen, when primary midline closure was impossible. The main aim was the anatomical reconstruction of the abdominal wall and the avoidance of dissecting techniques (component separation). Methods Between 2012 and 2019, 33 patients underwent AWEX hernia repair in three certified hernia centers. The retracted abdominal wall was stretched with the AWEX system intraoperatively for approximately 30 min. Hernia size was measured preoperatively, on CT, and intraoperatively. The gain in length on the lateral abdominal wall (decrease in width of the defect) after stretching and any residual midline gap were determined in the OR. Results 33 patients underwent AWEX procedures. Six cases were evaluated separately because of additional procedures (TAR, four cases) and preoperative application of botulinum toxin (two cases). The median (95% confidence interval) measured width of hernia defects was 13 (12–16) cm, the median gain in length on the lateral abdominal wall was 12 (10–15) cm. After median follow-up of 29 (12–54) months, one recurrence from the broken mesh was observed. No method-related complications occurred. Conclusion Based on the 2017 and current results, the AWEX system represents an alternative or supplemental procedure to current techniques for complex abdominal wall reconstruction. The system proved again to be time-saving, safe, effective, and easy to learn. Further studies with enhanced technology are in progress.

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Section: Procedures Characteristicscontrasting

confidence: 71%

Section: Principlesmentioning

confidence: 99%

Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study

et al. 2021

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“…This technique attempts to restore the space in the intra-abdominal cavity so that the chronically herniated visceral can be reintroduced into this space. 11 More recently, botulinum toxin type A has also been described as a preoperative adjunct used to temporarily paralyze abdominal wall muscles to facilitate tensionfree closure of the fascia during abdominal wall reconstruction. 12 Several series have been published highlighting the success of preoperative pneumoperitoneum, botulinum toxin, or both.…”

Section: Discussionmentioning

confidence: 99%

Can Hernia Sac to Abdominal Cavity Volume Ratio Predict Fascial Closure Rate for Large Ventral Hernia? Reliability of the Tanaka Score

Fafaj

Thomas

Zolin

et al. 2021

Journal of the American College of Surgeons

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BACKGROUND:The hernia sac to abdominal cavity volume ratio (VR) on abdominal CT was described previously as a way to predict which hernias would be less likely to achieve fascial closure.The aim of this study was to test the reliability of the previously described cutoff ratio in predicting fascial closure in a cohort of patients with large ventral hernias. METHODS:Patients who underwent elective, open incisional hernia repair of 18 cm or larger width at a single center were identified. The primary end point of interest was fascial closure for all patients. Secondary outcomes included operative details and abdominal wall-specific quality-of-life metrics. We used VR as a comparison variable and calculated the test characteristics (ie, sensitivity, specificity, and positive and negative predictive values). RESULTS:A total of 438 patients were included, of which 337 (77%) had complete fascial closure and 101 (23%) had incomplete fascial closure. The VR cutoff of 25% had a sensitivity of 76% (95% CI, 71% to 80%), specificity of 64% (95% CI, 54% to 74%), positive predictive value of 88% (95% CI, 83% to 91%), and negative predictive value of 45% (95% CI, 36% to 53%). The incomplete fascial closure group had significantly lower quality of life scores at 1 year (83.3 vs 52.5; p ¼ 0.001), 2 years (85 vs 33.3; p ¼ 0.003), and 3 years (86.7 vs 63.3; p ¼ 0.049). CONCLUSIONS: In our study, the VR cutoff of 25% was sensitive for predicting complete fascial closure for patients with ratios below this threshold. Although there is a higher likelihood of incomplete fascial closure when VR is ! 25%, this end point cannot be predicted reliably. Additional studies should be done to study this ratio in conjunction with other hernia-related variables to better predict this important surgical end point.

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“…9 A systematic review of the use of PPP by Martinez-Hoed et al found 53 articles that included 1 216 patients. 10 Their review noted that the most common indication of PPP was large IH with LOD. In 99.6%, the lost domain was reintroduced to the abdominal cavity and primary fascial closure was achieved in 86%.…”

Section: Discussionmentioning

confidence: 99%

Experience with insufflation technique in the management of incisional hernia with loss of domain

Bombil

Lushiku

2021

S. Afr. j. surg.

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BACKGROUND: The loss of intra-abdominal domain makes it impossible to reconstruct the abdominal wall defect without prior correction of container/content mismatch. This study reports on the use of an insufflation technique to enable repair METHOD: Over an 8-year period, 19 incisional hernia patients with loss of domain between 20% and 50% were treated with an insufflation technique to create sufficient intra-abdominal domain to effect repair. Ambient air was insufflated into the abdominal cavity via an indwelling catheter. After progressive pneumoperitoneum was completed over a period of 10 to 14 days, the hernias were repaired RESULTS: There were 16 females and three males. The defect size ranged from 7-25 cm. The mean air insufflated was 7.2 litres. After pneumoperitoneum, approximation of the linea alba was possible in all cases with a mean intraoperative pre-deflation and post-closure peak airway pressure within normal (21 and 20 cmH2O respectively). Tissue repair and implant reinforcement were performed in 17 and two cases respectively. There were three instances of surgical site complications and no 30-day recurrence CONCLUSION: Repair of incisional hernia with significant loss of domain was made possible by the insufflation technique that enabled tension-free closure of the abdominal wall defect by direct suture, evidenced by the normal peak airway pressure after closure Keywords: insufflation technique, incisional hernia, complications of laparotomy

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A systematic review of the use of progressive preoperative pneumoperitoneum since its inception

Cited by 44 publications

References 54 publications

Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study

Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study

Can Hernia Sac to Abdominal Cavity Volume Ratio Predict Fascial Closure Rate for Large Ventral Hernia? Reliability of the Tanaka Score

Experience with insufflation technique in the management of incisional hernia with loss of domain

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