Preoperative progressive pneumoperitoneum: The answer for treating giant inguinal hernias while avoiding morbidities?

Area of Science:

• Hernia Surgery
• Minimally Invasive Techniques
• Surgical Innovation

Background:

• Giant inguinal hernias (GIH) present a complex surgical challenge.
• Preoperative progressive pneumoperitoneum (PPP) is established for abdominal incisional hernias but less documented for GIH.
• Limited case reports exist for PPP in GIH treatment.

Purpose of the Study:

• To describe a technique for using PPP in treating GIH.
• To report outcomes in a series of patients with GIH managed with PPP.
• To evaluate the feasibility and initial results of PPP for GIH.

Main Methods:

• Retrospective review of 7 patients treated for GIH with PPP between 2012-2018.
• Analysis of patient demographics, preoperative, and surgical characteristics.
• All patients underwent the Lichtenstein repair following PPP.

Main Results:

• Seven patients with GIH were treated using PPP.
• Median PPP duration was 22 days; median follow-up was 12 months.
• Preoperative complications occurred in 42.8% (dyspnea, emphysema); postoperative complications in 28.5% (abscess, hydrocele).

Conclusions:

• PPP for GIH shows satisfactory initial results in this small series.
• Further comparative studies are required to establish PPP as a gold standard.
• The described technique offers a potential approach for managing challenging GIH cases.