Neumoperitoneo terapéutico preoperatorio en el tratamiento de la hernia incisional gigante. Reducción del volumen visceral como explicación fisiopatológica de sus beneficios

Abstract

IntroductionThe purpose of this paper is to present our preliminary experience in the treatment of large abdominal wall defects with progressive preoperative pneumoperitoneum, the use of computed tomography as a method of evaluating the usefulness of the pneumoperitoneum, and the visceral volume reduction concept, as an explanation for the beneficial effects. MethodsBetween the years 2008-2010, 5 patients whit large incisional hernia were admitted to the Hernia Surgery Unit at the Clinical Hospital of the University of Chile for progressive preoperative pneumopritoneum. Muscle elongation and visceral volume was assessed pre and post pneumoperitoneum. ResultsThe mean age was 54.8 years. The average length of the ring was 21 cm. Patients received preoperative pneumoperitoneum insufflation for an average of 13 sessions. The abdominal circumference increase of 13.5 cm measured by Computed Tomography. Intra-abdominal volume prior to progressive preoperative pneumoperitoneum was 10 708 ml and post pneumoperitoneum it was 15 000 ml, increasing by 40%. Total insufflated air volume was 10 570 ml, generating a difference of 5 708 ml that can be explained in part by decreased visceral volume, which reached 47%. Consequently, this would allow wall repair in all cases without morbidity. ConclusionsComputed Tomography assessment showed that progressive preoperative pneumoperitoneum allowed wall reppair of large deffects, increasing muscle lengs and reducing visceral volume.