Preoperative Progressive Pneumoperitoneum for Incisional Hernia Repair with Loss of Domain

Large complex ventral hernias associated with loss of domain pose several difficulties for surgical repair, as attempts to return the herniated contents to the peritoneal cavity may result in respiratory difficulty or significant intra-abdominal hypertension.1 There are several ways to address the i...

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Bibliographic Details
Published in:The American surgeon 2018-05, Vol.84 (5), p.748-749
Main Authors: Holzmer, Stephanie, Decino, Andrea, Mccarthy, Micheala, Okwuosa, Chris, Fitzgibbons, Robert J.
Format: Article
Language:English
Subjects:
Abdomen
Air filters
Catheters, Indwelling
Compartment syndrome
Hernia
Hernias
Herniorrhaphy - methods
Humans
Hypertension
Incisional Hernia - surgery
Laparoscopy - methods
Patients
Peritoneum - surgery
Pneumoperitoneum, Artificial - methods
Preoperative Care - methods
Surgery
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Summary:Large complex ventral hernias associated with loss of domain pose several difficulties for surgical repair, as attempts to return the herniated contents to the peritoneal cavity may result in respiratory difficulty or significant intra-abdominal hypertension.1 There are several ways to address the issue of loss of domain, including component separation, bridging with synthetic material, and botulinum toxin use; however, there are cases in which these techniques fail.2 In these situations, surgeons caring for complex abdominal wall hernias should also be prepared to use preoperative progressive pneumoperitoneum (PPP) when necessary. A needle is then placed through the lower portion of the port pocket into the abdominal cavity, just to the right of the falciform ligament, which is followed by the introduction of a guidewire and tear-away introducer. By allowing for preoperative expansion of the peritoneal cavity, patients experience successful reduction of hernia contents with reduced time in the operating room, reduced length of hospital stay, decreased analgesic requirement, and decreased risk for development of respiratory complications whereas avoiding abdominal compartment syndrome.
ISSN:0003-1348
1555-9823
DOI:10.1177/000313481808400530