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Progressive preoperative pneumoperitoneum in the repair of large abdominal hernias
J C Coelho1, A S Brenner, A T Freitas
1Department of Surgery of the Federal University of Paraná, Curitiba, Brazil.
Objective:
To present our experience of progressive preoperative pneumoperitoneum in the preparation of patients for repair of large hernias of the abdominal wall.
Design:
Prospective selected series.
Setting:
A university hospital and a district hospital.
Subjects:
36 Patients of the 252 who presented for abdominal hernia repair between January 1977 and April 1992.
Interventions:
Air was insufflated into the peritoneal cavity through a 19 gauge spinal needle, and between 500 and 2000 ml was usually injected at the first session. Amounts were gradually increased daily or every other day for a period of 6-15 days; the total amount insufflated ranged from 4500-18,500 (mean 7700) ml.
Main Outcome Measures:
Whether the hernia could be repaired directly without recourse to polypropylene mesh, complications of pneumoperitoneum, and recurrence rate.
Results:
In one patient air was insufflated into the colon, one developed temporary but severe respiratory distress, and 4 developed moderate subcutaneous emphysema. 30 hernias were repaired directly, and 6 required polypropylene mesh. There were three wound infections (two after direct repair), and two recurrences (both after direct repair). Mean length of follow up was 10 months (range 1-48).
Conclusion:
Progressive preoperative pneumoperitoneum allows direct repair of some large abdominal hernias with a low recurrence rate, and few complications.
