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Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia

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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.

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Author information

Authors and Affiliations

  1. Surgical Unit of Abdominall Wall, Department of Digestive Surgery, “La Fe” Universitary Hospital, University of Valencia, Avd. Fernando Abril Martorell 106, 46126, Valencia, Spain

    J. Bueno-Lledó, A. Torregrosa, N. Ballester, O. Carreño, P. G. Pastor, S. Bonafé & J. Iserte

  2. Department of Radiology, “La Fe” Universitary Hospital, Valencia, Spain

    J. Pamies

  3. Department of Neurophysiology, “La Fe” Universitary Hospital, Valencia, Spain

    V. Cortés

  4. Department of Surgery, Instituto Valenciano de Oncología (IVO), Valencia, Spain

    F. Carbonell

Authors
  1. J. Bueno-Lledó
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  2. A. Torregrosa
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  3. N. Ballester
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  4. O. Carreño
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  5. F. Carbonell
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  6. P. G. Pastor
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  7. J. Pamies
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  8. V. Cortés
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  9. S. Bonafé
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  10. J. Iserte
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Corresponding author

Correspondence to J. Bueno-Lledó.

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All authors declare no conflict of interest.

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All procedures performed in studies involving humanparticipants were in accordance with the ethical standards of the institucional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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This article does not contain any study with animals performed by any of the authors.

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Informed consent was obtained from all individual participants included in the study.

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Bueno-Lledó, J., Torregrosa, A., Ballester, N. et al. Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia. Hernia 21, 233–243 (2017). https://doi.org/10.1007/s10029-017-1582-2

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  • DOI: https://doi.org/10.1007/s10029-017-1582-2

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