Preoperative Progressive Pneumoperitoneum and Botulinum Toxin Type A in Patients with Large Incisional Hernia

Overview

Journal Hernia

Publisher Springer

Date 2017 Jan 27

PMID 28124308

Citations 34

Authors

J Bueno-Lledo

A Torregrosa

N Ballester

O Carreno

F Carbonell

P G Pastor

J Pamies

V Cortes

S Bonafe

J Iserte

Affiliations

Soon will be listed here.

Abstract

Purpose: Combination of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BT) has not been previously reported in the management of large incisional hernia (LIH).

Methods: Observational study of 45 consecutive patients with LIH between June 2010 and July 2014. The diameters of the hernia sac, the volumes of the incisional hernia (VIH) and the abdominal cavity (VAC), and the VIH/VAC ratio were measured before and after PPP and BT using abdominal CT scan data. We indicated the combination of both techniques when the volume of the incisional hernia (VIH)/volume of the abdominal cavity (VAC) ratio was >20%.

Results: The median insufflated volume of air for PPP was 8.600 ± 3.200 cc (4.500-13.250), over a period of 14.3 ± 1.3 days (13-16). BT administration time was 40.2 ± 3.3 days (37-44). We obtained an average value of reduction of 14% of the VIH/VAC ratio after PPP and BT (p < 0.05). Complications associated with PPP were 15.5%, and with surgical technique, 26.6%. No complications occurred during the BT administration. Reconstructive technique was anterior CST and primary fascial closure was achieved in all patients. Median follow-up was 40.5 ± 19 months (12-60) and we reported 2 cases of hernia recurrence (4.4%).

Conclusions: Preoperative combination of PPP and BT is feasible and a useful tool in the surgical management of LIH, although at the cost of some specific complications.

Citing Articles

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References

Ramirez O, Ruas E, Dellon A . "Components separation" method for closure of abdominal-wall defects: an anatomic and clinical study. Plast Reconstr Surg. 1990; 86(3):519-26. DOI: 10.1097/00006534-199009000-00023. View

Luder P, Haller B, Gertsch P, Blumgart L, Lerut J . [Pneumoperitoneum and Mersilene mesh in the treatment of giant abdominal wall hernias]. Helv Chir Acta. 1990; 56(6):927-30. View

Sabbagh C, Dumont F, Fuks D, Yzet T, Verhaeghe P, Regimbeau J . Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study. Hernia. 2011; 16(1):33-40. DOI: 10.1007/s10029-011-0849-2. View

Slater N, Montgomery A, Berrevoet F, Carbonell A, Chang A, Franklin M . Criteria for definition of a complex abdominal wall hernia. Hernia. 2013; 18(1):7-17. DOI: 10.1007/s10029-013-1168-6. View

Dumont F, Fuks D, Verhaeghe P, Brehant O, Sabbagh C, Riboulot M . Progressive pneumoperitoneum increases the length of abdominal muscles. Hernia. 2008; 13(2):183-7. DOI: 10.1007/s10029-008-0436-3. View

Mcadory R, Cobb W, Carbonell A . Progressive preoperative pneumoperitoneum for hernias with loss of domain. Am Surg. 2009; 75(6):504-8. View

M Quraishi A, Borkar M, Mastud M, Jannawar G . Pre-operative progressive pneumoperitoneum for repair of a large incisional hernia. Updates Surg. 2012; 65(2):165-8. DOI: 10.1007/s13304-012-0134-7. View

Lopez Sanclemente M, Robres J, Lopez Cano M, Barri J, Lozoya R, Lopez S . [Progressive preoperative pneumoperitoneum in patients with giant hernias of the abdominal wall]. Cir Esp. 2013; 91(7):444-9. DOI: 10.1016/j.ciresp.2012.08.004. View

Walker H, Lee M, Bahroo L, Hedera P, Charles D . Botulinum toxin injection techniques for the management of adult spasticity. PM R. 2014; 7(4):417-27. DOI: 10.1016/j.pmrj.2014.09.021. View

10.

Klinge U, Conze J, Krones C, Schumpelick V . Incisional hernia: open techniques. World J Surg. 2005; 29(8):1066-72. DOI: 10.1007/s00268-005-7970-2. View

11.

Coelho J, Brenner A, Freitas A, Campos A, Wiederkehr J . Progressive preoperative pneumoperitoneum in the repair of large abdominal hernias. Eur J Surg. 1993; 159(6-7):339-41. View

12.

Sabbagh C, Dumont F, Robert B, Badaoui R, Verhaeghe P, Regimbeau J . Peritoneal volume is predictive of tension-free fascia closure of large incisional hernias with loss of domain: a prospective study. Hernia. 2011; 15(5):559-65. DOI: 10.1007/s10029-011-0832-y. View

13.

Jones C, Winder J, Potochny J, Pauli E . Posterior Component Separation with Transversus Abdominis Release: Technique, Utility, and Outcomes in Complex Abdominal Wall Reconstruction. Plast Reconstr Surg. 2016; 137(2):636-646. DOI: 10.1097/01.prs.0000475778.45783.e2. View

14.

Deerenberg E, Timmermans L, Hogerzeil D, Slieker J, Eilers P, Jeekel J . A systematic review of the surgical treatment of large incisional hernia. Hernia. 2014; 19(1):89-101. DOI: 10.1007/s10029-014-1321-x. View

15.

Breuing K, Butler C, Ferzoco S, Franz M, Hultman C, Kilbridge J . Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery. 2010; 148(3):544-58. DOI: 10.1016/j.surg.2010.01.008. View

16.

Zielinski M, Goussous N, Schiller H, Jenkins D . Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen. Hernia. 2012; 17(1):101-7. DOI: 10.1007/s10029-012-0995-1. View

17.

Mayagoitia J, Suarez D, Arenas J, Diaz de Leon V . Preoperative progressive pneumoperitoneum in patients with abdominal-wall hernias. Hernia. 2005; 10(3):213-7. DOI: 10.1007/s10029-005-0040-8. View

18.

Muysoms F, Miserez M, Berrevoet F, Campanelli G, Champault G, Chelala E . Classification of primary and incisional abdominal wall hernias. Hernia. 2009; 13(4):407-14. PMC: 2719726. DOI: 10.1007/s10029-009-0518-x. View

19.

Cakmak M, Caglayan F, Somuncu S, Leventoglu A, Ulusoy S, Akman H . Effect of paralysis of the abdominal wall muscles by botulinum A toxin to intraabdominal pressure: an experimental study. J Pediatr Surg. 2006; 41(4):821-5. DOI: 10.1016/j.jpedsurg.2005.12.023. View

20.

Caldironi M, Romano M, Bozza F, Pluchinotta A, Pelizzo M, Toniato A . Progressive pneumoperitoneum in the management of giant incisional hernias: a study of 41 patients. Br J Surg. 1990; 77(3):306-7. DOI: 10.1002/bjs.1800770322. View