Preoperative Preparation of “Loss of Domain” Hernia. Progressive Pneumoperitoneum and Botulinum Toxin Type A

Bueno-Lledó, José; Gallud, Antonio Torregrosa; Rosellón, Raquel Jiménez; Tatay, Fernando Carbonell; Pastor, Providencia García; Diana, Santiago Bonafé; Hernández, José Iserte

doi:10.1016/j.cireng.2017.06.002

Cited by 12 publications

(12 citation statements)

References 35 publications

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“…When the two techniques are combined, the need for prolonged insufflation is negated, and subsequently, PPP insufflation need only be performed for a few days prior to surgery. Bueno-Lledo et al ( 11 , 12 ) have reported the largest cohort of patients treated with BTA and PPP prior to surgery for large incisional hernia. Eighty patients who presented electively with large incisional hernias with volume of incisional hernia/volume of abdominal cavity (VIH/VAC) ratio > 20% were given BTA at 40 days pre-operatively, and then PPP at 14 days preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Preoperative Progressive Pneumoperitoneum Revisited

et al. 2021

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Incisional hernia represents a common and potentially serious complication of open abdominal surgery, with up to 20% of all patients undergoing laparotomy subsequently developing an incisional hernia. This incidence increases to as much as 35% for laparotomies performed in high-risk patients and emergency procedures. A rarely used technique for enabling closure of large ventral hernias with loss of domain is preoperative progressive pneumoperitoneum (PPP), which uses intermittent insufflation to gradually stretch the contracted abdominal wall muscles, increasing the capacity of the abdominal cavity and allowing viscera to re-establish right of domain. This assists in tension-free closure of giant hernias which may otherwise be considered inoperable. This technique may be used on its own, or in conjunction with preoperative Botulinum Toxin A to confer paralysis to the lateral oblique muscles. These two complementary techniques, are changing the way complex hernias are managed.

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Section: Discussionmentioning

confidence: 99%

Preoperative Progressive Pneumoperitoneum Revisited

et al. 2021

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“…[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%

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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“…La administración diaria puede realizarse en visitas domiciliarias o en régimen de cirugía ambulatoria. Por último, al final del proceso se suele realizar un último control de TC abdominal, con el objeto de calcular el volumen de la cavidad y la nueva relación entre volumen herniario y volumen de la cavidad abdominal 11 .…”

Section: Introductionunclassified

“…Por otro lado, la técnica de infiltración de toxina botulínica, a pesar de su relativamente reciente incorporación, es una herramienta útil en la preparación prequirúrgica de las hernias con pérdida de domicilio, al actuar como una separación de componentes «química» reversible y con mínimas molestias para el paciente. Además, presenta la ventaja de que la acción continúa en el posoperatorio tardío, unos 6 meses, en los que el abdomen operado va adaptando estos cambios 11 .…”

Section: Introductionunclassified