Application value of the preoperative progressive pneumoperitoneum in the elderly with large incisional hernia

Abstract

Objective To investigate the clinical application value of the preoperative progressive pneumoperitoneum (PPP) in the treatment of large incisional hernias in the elderly. Methods The clinical data of 19 elderly patients with large incisional hernia who underwent PPP prior to hernia repair in the Sixth Hospital Affiliated of Sun Yat-sen University from February 2017 to February2018 were analyzed retrospectively. Abdominal computed tomography (CT) scan, pulmonary function and arterial blood gas analysis were performed before and after PPP. The following indicators were mainly observed: (1) PPP situations: insufflation time (days), completion, the median insufflated volume of air; (2) Changes in the volumes of the incisional hernia (VIH), the volumes of the abdominal cavity (VAC), the pulmonary function and arterial blood gas (PaO2 and PaCO2) before and after PPP; (3) operation, postoperative recovery and follow-up situations. Results (1) PPP situations: the insufflation time in 19 patients ranged from 11-18 d, 18 patients successfully completed PPP, the median insufflated volume of air for PPP was 4 400-7 200 mL. (2) Changes in the volumes of the incisional hernia (VIH), the volumes of the abdominal cavity (VAC), the pulmonary function and arterial blood gas (PaO2 and PaCO2) before and after PPP: Before and after PPP, the mean VIH was (1 086.7±438.9) mL and (1 275.8±521.4) mL (t=3.228, P 0.05), FEV1 decreased by 6.52% (t=2.137, P 0.05) and PaCO2 decreased by 9.14% (t=3.39). (3) Operation, postoperative recovery and follow-up situations: The operations was performed successfully in 19 patients, the mean operating time was 137 to 265 minutes, fascia closure was possible in 89.5% of cases (n=17). No severe complications such as ACS or cardiopulmonary failure occurred. The mean postoperative length of stay in hospital was 4 to 12 days. All patients were followed up for 6-18 months, and there was no hernia recurrence. Conclustion PPP is safe and effective in elderly patients with large incisional hernia repair, which is worthy of clinical promotion and application. Key words: Large incisional hernia; Preoperative progressive pneumoperitoneum; Elderly; Hernia repair; Complication