Abstract
Background: The combination of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BTA) in adjuvant treatment of large parastomal hernia (LPH) has not been reported in the previous literature.Methods: From February 2018 to June 2019, 16 patients were diagnosed with LPH in our hospital were included in this study. All patients received PPP and BTA treatment to expand abdominal volume and extend abdominal muscle before surgery. The laparoscopic Sugarbaker method was preferred for defect close.Results: Before and after PPP and BTA, the mean volume of the parastomal hernia (VPH) was 1,522 and 1,644 cc, respectively (P < 0.01), and the mean volume of the abdominal cavity (VAC) was 5,847 and 9,408 cc, respectively (P < 0.01). The VPH/VAC ratio was decreased by an average of 8.4% after the combination management. And the lateral abdominal muscle length was increased by an average of 4.8 cm/side (P < 0.01). These patients underwent surgery successfully, and no hernia recurrence after (17.6 ± 2.4) months of follow-up.Conclusions: The combination of PPP and BTA effectively expand the abdominal volume, decrease the risk of abdominal compartment syndrome (ACS) postoperatively, and beneficial to laparoscopic repair of LPH.
Highlights
Despite recent advances in surgical techniques, repair of parastomal hernia (PSH) is still a huge challenge for surgeons following abdominal ostomy [1]
According to PSH grade, two patients were classified as Grade I (12.5%), eleven as Grade III (68.8%), and three as Grade IV (18.8%)
There is no definition of large parastomal hernia (LPH) in the literature, and we defined LPH as a large incisional hernia (LIH) with LODH ratio of ≥20% (VPH/volume of the abdominal cavity (VAC) ≥ 20%)
Summary
Despite recent advances in surgical techniques, repair of parastomal hernia (PSH) is still a huge challenge for surgeons following abdominal ostomy [1]. Permanent end colostomy has a higher incidence of PSH, estimated as up to 78% as revealed by computed tomography (CT) [4]. These patients may present with leakage of fecal material from the appliance, resulting in contact. PPP and BTA in LPH dermatitis, and abdominal pain or incarceration or strangulation of the hernia, which may require emergency repair. These conditions seriously affect the patient’s quality of life [5]. The combination of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BTA) in adjuvant treatment of large parastomal hernia (LPH) has not been reported in the previous literature
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