Preoperative Progressive Pneumoperitoneum in the Treatment of Hernias With Loss of Domain. Our Experience in 50 Cases.

Introduction: Surgical planning for repair of giant hernias with loss of domain needs to consider patient comorbidities, potential risks and possible postoperative complications. Some postoperative complications are related to the increase in intra-abdominal pressure caused by the reintroduction of abdominal contents into the peritoneal space. Preoperative progressive pneumoperitoneum (PPP) increases the capacity of abdominal cavity prior to hernia repair and allows for better physiological postoperative adaptation. The aim of this study is to analyze perioperative and intraoperative characteristics as well as outcomes of a cohort of patients treated with PPP prior to giant hernia repair at a single, high volume center. Methods: Prospective, descriptive, observational single-center study including 50 patients undergoing PPP prior to hernia with loss of domain repair between January 2005 and June 2022. We analysed epidemiological, surgical and safety variables. Results: Fifty patients were included: 43 incisional hernias, 6 inguinal hernias and 1 umbilical hernia. Mean age was 66 years (36-85). Median insufflation time was 12 days (4-20) and median insufflated volume of ambient air was 10,036 cc. There were complications during PPP in nine patients: 2 decompensation of chronic respiratory disease and 7 subcutaneous emphysema. PPP was prematurely suspended in patients with respiratory decompensation. All patients with incisional and umbilical hernias underwent open repair with mesh placement. Preperitoneal repair was performed in inguinal hernias. Three cases of hernia recurrence were reported during the follow up. Conclusion: PPP is a safe and effective tool in the preoperative management of patients with giant hernias. It helps to achieve the decrease or absence of abdominal wall tension and can favour the results of complex eventroplasty techniques.

Single-incision versus four-port laparoscopic cholecystectomy in an ambulatory surgery setting: A prospective randomised double-blind controlled trial.

BACKGROUND: Single-incision laparoscopic cholecystectomy (SILC) can be done as a day-case procedure and may have advantages over conventional laparoscopic cholecystectomy (LC). We present the results of our study looking at post-operative pain and post-operative recovery time. METHODS: This was a single-institution randomised double-blind controlled trial. Seventy-three patients with symptomatic cholelithiasis were randomized to SILC (n = 37) or LC (n = 36). The primary endpoint was to compare post-operative pain. We also compared surgical time, procedural difficulty, adverse events, additional ports used and conversion rate, success of day surgery process, return to work, aesthetic satisfaction, quality of life and 4-year incisional hernia rate. RESULTS: In the SILC group, post-operative analgesic requirements were lower on day 7, there was an earlier return to work and cosmetic satisfaction was significantly higher. The SILC procedure presented a higher technical difficulty. Operative time, surgical complications, post-operative pain, success of the day-case process, return to normal activity, quality of life scores and incisional hernia rates were similar for both the procedures. CONCLUSIONS: SILC has advantages over LC in terms of late post-operative analgesic requirements and aesthetic results; however, it is technically harder to perform. There was no benefit in terms of day surgery outcomes.

Neumoperitoneo preoperatorio progresivo en pacientes con hernias gigantes de la pared abdominal / Progressive preoperative pneumoperitoneum in patients with giant hernias of the abdominal wall

Introducción Los pacientes con hernias gigantes con pérdida de domicilio requieren una adecuada planificación de la reparación quirúrgica, porque en la mayoría se asocia una elevada comorbilidad. La técnica del neumoperitoneo progresivo preoperatorio descrita por Goñi Moreno permite una adaptación más fisiológica del paciente y de la cavidad abdominal al reintegro de las vísceras al abdomen, lo que permite una reparación quirúrgica adecuada. El objetivo es analizar nuestra experiencia en el tratamiento de este tipo de hernias. Materiales y métodos Estudio retrospectivo en que se analizan 11 pacientes portadores de grandes defectos de pared abdominal, con pérdida de domicilio, tratados mediante dicha técnica, en 2 centros entre los años 2005 y 2010.ResultadosDel total, ocho pacientes presentaban eventraciones abdominales y los otros 3 tenían hernias inguinales. El tiempo medio de insuflación fue de 2 semanas y la cantidad total de aire varió entre 6,6 y 18 l. Dos pacientes presentaron descompensación de su enfermedad pulmonar y se debió posponer temporalmente la insuflación. Otros 2 presentaron enfisema subcutáneo durante los últimos días de insuflación, que se resolvió espontáneamente y sin secuelas. Se utilizaron técnicas de eventroplastia abierta con malla en los 8 casos de eventraciones y técnica preperitoneal para las hernias inguinoescrotales. En el seguimiento posterior se objetivó un caso de recidiva. Conclusiones La técnica de Goñi Moreno sigue siendo una técnica segura para preparar a los pacientes con hernias gigantes con pérdida de domicilio, pues consigue reducir la morbilidad ocasionada por la hiperpresión abdominal tras la reparación de la pared abdominal (AU)

Introduction Patients with giant hernias with loss of domain require proper planning of surgical repair, because of the high associated comorbidity. The progressive preoperative pneumoperitoneum technique described by Goñi Moreno allows a more physiological adaptation of the patient and the abdominal cavity to the reinstatement of the viscera to the abdomen, enabling adequate surgical repair. The objective of this study was to analyze our experience in the treatment of this type of hernia. Materials and methods We carried out a retrospective study that included 11 patients with major abdominal wall defects and loss of domain who were treated with this technique in 2 centers between 2005 and 2010.ResultsEight patients had abdominal hernias and 3 had inguinal hernias. The average insufflation time was 2 weeks and the total amount of air was between 6.6 and 18 l. In 2 patients who showed pulmonary disease decompensation, insufflation had to be temporarily postponed. A further 2 patients had subcutaneous emphysema during the last few days of insufflation, which resolved spontaneously without sequelae. The open mesh repair technique was used in ventral hernias and the preperitoneal technique in all inguinal hernias. There was one recurrence during the 1-year follow-up. Conclusions Goñi Moreno's technique remains safe to prepare patients with giant hernias with loss of domain. This procedure can reduce the morbidity caused by the increase in abdominal pressure after abdominal wall repair (AU)

[Progressive preoperative pneumoperitoneum in patients with giant hernias of the abdominal wall]. / Neumoperitoneo preoperatorio progresivo en pacientes con hernias gigantes de la pared abdominal.

INTRODUCTION: Patients with giant hernias with loss of domain require proper planning of surgical repair, because of the high associated comorbidity. The progressive preoperative pneumoperitoneum technique described by Goñi Moreno allows a more physiological adaptation of the patient and the abdominal cavity to the reinstatement of the viscera to the abdomen, enabling adequate surgical repair. The objective of this study was to analyze our experience in the treatment of this type of hernia. MATERIALS AND METHODS: We carried out a retrospective study that included 11 patients with major abdominal wall defects and loss of domain who were treated with this technique in 2 centers between 2005 and 2010. RESULTS: Eight patients had abdominal hernias and 3 had inguinal hernias. The average insufflation time was 2 weeks and the total amount of air was between 6.6 and 18 l. In 2 patients who showed pulmonary disease decompensation, insufflation had to be temporarily postponed. A further 2 patients had subcutaneous emphysema during the last few days of insufflation, which resolved spontaneously without sequelae. The open mesh repair technique was used in ventral hernias and the preperitoneal technique in all inguinal hernias. There was one recurrence during the 1-year follow-up. CONCLUSIONS: Goñi Moreno's technique remains safe to prepare patients with giant hernias with loss of domain. This procedure can reduce the morbidity caused by the increase in abdominal pressure after abdominal wall repair.