Combination of Preoperative Progressive Pneumoperitoneum and Botulinum Toxin A Enables the Laparoscopic Transabdominal Preperitoneal Approach for Repairing Giant Inguinoscrotal Hernias

Abstract

Background: Reports on preoperative progressive pneumoperitoneum (PPP) and botulinum toxin A (BTA) for managing giant inguinoscrotal hernias are limited. Hence, we report our experience with these preoperative techniques in patients with this condition. Materials and Methods: Observational study of 8 consecutive patients with giant inguinoscrotal hernias between January 2018 and December 2018. All patients were treated preoperatively with BTA injection to the lateral abdominal wall muscles and PPP for passive abdominal cavity expansion. Length of abdominal wall muscles, volume of inguinal hernia (VIH), volume of the abdominal cavity (VAC), and VIH/VAC ratio were measured before and after PPP and BTA using abdominal computed tomography. All hernias were repaired laparoscopically using transabdominal preperitoneal (TAPP) repair techniques. Results: The mean insufflated volume of air for PPP was 5625 ± 845 mL for 15.4 ± 1.6 days. An average reduction of 5.3% of the VIH/VAC ratio after PPP and BTA was obtained (P < .01). The length of lateral abdominal muscles with a mean gain of 3.3 cm/side (P < .01) and complications associated with PPP were 12.5% and with surgical technique, 25%. Laparoscopic TAPP repair was achieved in all cases, with no clinical evidence of postoperative abdominal hypertension. The mean follow-up was 22 months; no hernia recurrences have been reported. Conclusions: Combination of PPP and BTA is feasible and useful for surgically managing giant inguinoscrotal hernias, which can avoid abdominal compartment syndrome after laparoscopic TAPP repair of giant inguinoscrotal hernias.