[Preoperative progressive pneumoperitoneum in voluminous abdominal wall hernias]

Area of Science:

• Abdominal wall surgery
• Surgical innovation
• Hernia repair techniques

Context:

• Large abdominal wall defects and voluminous hernias pose significant surgical challenges.
• High incidence of respiratory and cardiovascular complications complicates surgical repair.
• Loss of domain in the abdominal cavity presents a specific difficulty.

Purpose:

• To evaluate the authors' experience with preoperative progressive pneumoperitoneum for voluminous abdominal wall hernias.
• To assess the safety and efficacy of this technique in surgical practice.

Summary:

• A retrospective study of six patients with voluminous hernias underwent preoperative progressive pneumoperitoneum via a left hypochondrium catheter with ambient air.
• Pneumoperitoneum was maintained for 10–15 days, with a mean of 11.6 days, without complications.
• All hernias were successfully repaired using various techniques (Lichtenstein, peritoneal aponeurotic transposition, polypropylene mesh), with no reported recurrences at 4–36 months follow-up. One death and one wall infection occurred postoperatively.

Impact:

• Preoperative progressive pneumoperitoneum is a safe, easily executed procedure.
• Simplifies surgical correction of complex hernias.
• Reduces postoperative respiratory and cardiovascular complications, particularly in cases with lost domain.