Use of progressive pneumoperitoneum in the repair of giant hernias

Summary

Preoperative progressive pneumoperitoneum is a well-known, but sporadically used procedure in preparing patients with giant inguinal or incisional hernias for operation. The technique requires the frequent insufflation of air into the abdominal cavity in order to make room to accommodate herniated viscera and facilitate fascial repair with minimal tension. In 11 patients with giant inguinal and incisional hernias a preoperative progressive pneumoperitoneum was performed. Due to a lack of compliance it had to be terminated without operation in one patient. Minor complications appeared in almost all patients, but after pneumoperitoneum a tension-free closure of the fascial defect was successful in all patients. The direct suture of the defect was successful in 4 patients with primary hernias, while in all cases of recurrent hernias an additional fascial augmentation by alloplastic meshes was required. Until now no recurrences have appeared. We conclude that the progressive pneumoperitoneum is a useful adjunct in the preoperative preparation of patients with giant hernias. It is not a competing, but a complementary procedure to mesh repair in patients with huge defects or fascial weakness.