Surgical Endoscopy

, Volume 32, Issue 8, pp 3599–3608 | Cite as

Preoperative combination of progressive pneumoperitoneum and botulinum toxin type A in patients with loss of domain hernia

  • José Bueno-Lledó
  • Antonio Torregrosa
  • Raquel Jiménez
  • Providencia García Pastor



Preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BT) are tools in the surgical preparation of patients with loss of domain hernias (LODH). The aim of this paper is to report our experience with these preoperative techniques in 70 patients with LODH.


Observational study of 70 consecutive patients with LODH was conducted between May 2010 and May 2016. Diameters of the hernia sac, incisional hernia (VIH), and abdominal cavity (VAC) volumes, and VIH/VAC ratio were measured before and after PPP and BT, using abdominal CT scan data. Combination of both techniques was performed when the VIH/VAC ratio was > 20%.


Median insufflated volume of air for PPP was 8450 ± 3400 cc (4500–13,450), over a period of 11.3 ± 2.3 days (9–16). BT administration time was 38.1 ± 3.7 days (35–44). An average reduction of 16.6% of the VIH/VAC ratio after PPP and BT was obtained (p < 0.05). Complications associated with PPP were 20%, and with surgical technique 29.6%. No complications occurred during the BT administration. Reconstructive technique was anterior CST in 54 patients, TAR in 14 cases and Rives–Stoppa technique in two patients. Median follow-up was 34.5 ± 22.3 months (12–60) and four cases of hernia recurrence (5.7%) were reported.


Using a CT volumetric protocol, combination of PPP and BT decreases the VIH/VAC ratio and hernia defect diameters, which constitutes a key factor in the treatment of LODH.


Botulinum toxin Progressive pneumoperitoneum Ventral hernia Incisional hernia Loss of domain hernia 


Compliance with ethical standards


Drs. Bueno-Lledó, Torregrosa, Jiménez, and García Pastor have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Surgical Unit of Abdominall wall, Departament of Digestive Surgery, “La Fe” Universitary HospitalUniversity of ValenciaValenciaSpain

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