P009 BEYOND TANAKA INDEX: PREOPERATIVE ASSESSMENT WITH 3D TECHNOLOGY IN LARGE HERNIAS WITH LOSS OF DOMAIN

Abstract

Abstract Aim “Demonstrate step by step the planning that was carried out using 3D technology in pre-surgical assessment for complex hernia.” Material and Methods “57-year-old female, surgical record of laparoscopic uterine myomectomy 20 years ago, has an eventration with loss of domain on the left flank and a giant uterine myoma. A multidisciplinary assessment was carried out for surgical decision, myomectomy was rejected. Presurgical preparation was decided with progressive pneumoperitoneum (PPP) technique (1 week before surgery) associated with botulinum toxin (4 weeks before surgery). The patient specific volumes of the abdominal cavity and the eventration were measured with 3D technology resulting in a volume ratio (VR) of 34% pre-PPP, VR post-PPP and botulinum toxin was 9,8%. We compared these results to Tanaka index and we found a significant difference between the two techniques.” Results “During surgical intervention, multiple tumors were evidenced in the hernia content, distal ileum, cecum and omentum, peroperative pathological anatomy reported leiomyomas. An ileocecal resection+Omentectomy+TAR was performed. Patient was discharged on the 5th day without incidents. A definitive diagnosis of Diffuse Peritoneal Leiomyomatosis was made.” Conclusions “3D technology might represent a better tool to calculate intraabdominal and hernia volume, providing greater safety for the patient and the surgeon to avoid compartment syndrome. We found a significant difference between volumes measurements between Tanaka index and 3D technology. 3D technology gives us an unprecedented perspective for surgical planning in complex abdominal wall surgery The use of PPP and botulinum toxin is a safe and reproducible technique for hernia with loss of domain.”