P-025 Use of Preoperatory Pneumoperitoneum for Giant Inguinoescrotal Hernia Treatment With Loss of Domain. A Great Resourse

Abstract

Introduction Recently, the use of neoadjuvant therapies such as preoperative progressive pneumoperitoneum has favored the treatment of large ventral hernias with loss of domain. Despite this, there are only few cases described in the literature. Materials & Methods We present a case of a 69-year-old male affected by giant inguinoescrotal hernia of years of evolution with loss of domain. A preoperative CT scan with volumetric quantification is performed where giant left inguinal hernia with mesenteric fat content, small intestine, sigma, descending colon, as well as splenic angle of the colon, with a relationship between the volumes greater than 0.67. (VSH of 11,502cc and VABD of 17,061cc). We decided to perform preoperative progressive pneumoperitoneum. In the following 15 days up to 8L are administered without complications. Results Surgical repair of the inguinal hernia is performed according to the Lichtenstein technique modified by the size of the hernial sac with evidence of unstructured but intact structures of the inguinal canal. Placement of self-adhesive ProGrip TM retroaponeurotic mesh is performed with attachment of this to the inguinal ligament and pubis. After surgery, the patient presented a good postoperative recovery without complications, without evidence of recurrence more than 6 months after surgery. Discussion The use of prehabilitating techniques in patients affected by large hernias can reduce the morbidity and mortality of patients, with the less aggression. In our case it allowed us to completely reduce all the hernia contents without visceral injury and perform an anatomical repair, which would not have been possible without this resource.