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Complications related to the prehabilitation with preoperative pneumoperitoneum in loss of domain hernias: our experience in 180 consecutive cases

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Abstract

Objective

Progressive pneumoperitoneum (PPP) is useful tool in the preparation of patients with loss of domain hernias (LODH). The purpose of this observational retrospective study was to report our experience in the management of complications associated with the PPP procedure after treating 180 patients with LODH and to report preventive measures to avoid them.

Methods

Of the 971 patients with a ventral incisional hernia operated on between June 2012 and July 2022, 180 consecutive patients with LODH were retrospectively analysed. Diameters of abdominal cavity, and volumes of incisional hernia and abdominal cavity were calculated from CT scan, based on the modified index of Tanaka. Complications related to the PPP procedure (catheter placement and following insufflations of air) were recorded by Clavien–Dindo classification.

Results

Complications associated to PPP were 26.6%. No complications occurred during the administration of botulinum toxin (BT). Eighteen patients (10% of 180 patients) developed subcutaneous emphysema during the last days of the insufflations; there were 2 accidental perforations of the small bowel and four punctures with liver and splenic hematomas, detected during catheter placement; a laparotomy, however, was not needed because it was solved with conservative treatment. We diagnosed it as a peritoneum-cutaneous fistula due to the cutaneous atrophy secondary to chronic eventration.

Conclusion

PPP is a safe technique well tolerated by patients, although at the cost of some specific complications. Hernia surgeons must understand these complications to prevent them and to inform the LODH patient about their existence.

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors and Affiliations

  1. Unit of Abdominal Wall Surgery. Department of Digestive Surgery, Hospital Universitari i Politecnic “La Fe”. University of Valencia, Calle Gabriel Miró 28, puerta 12, 46008, Valencia, Spain

    J. Bueno-Lledó, S. Bonafé-Diana, P. García-Pastor, A. Torregrosa-Gallud, V. Pareja-Ibars, O. Carreño-Sáenz & S. Pous-Serrano

  2. Hospital R. A. Calderón Guardia, San José, Costa Rica

    J. Martínez-Hoed

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  1. J. Bueno-Lledó
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  2. J. Martínez-Hoed
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  3. S. Bonafé-Diana
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  4. P. García-Pastor
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  5. A. Torregrosa-Gallud
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  6. V. Pareja-Ibars
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  7. O. Carreño-Sáenz
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  8. S. Pous-Serrano
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Correspondence to J. Bueno-Lledó.

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Bueno-Lledó, J., Martínez-Hoed, J., Bonafé-Diana, S. et al. Complications related to the prehabilitation with preoperative pneumoperitoneum in loss of domain hernias: our experience in 180 consecutive cases. Hernia (2023). https://doi.org/10.1007/s10029-023-02836-6

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