Ramirez's Abdominoplasty Technique Combined With Intraperitoneal Chemohyperthermia After Surgical Cytoreductive Procedures for the Treatment of Advanced Intraperitoneal Cancer in Patients With Ventral Hernia

Abstract

Patients affected by peritoneal carcinomatosis are frequently submitted to repeated laparotomies to reduce intra-abdominal bulky lesions and to enhance the systemic chemotherapeutic action. Aim of our study is to evaluate feasibility and results of cytoreductive surgery and intraperitoneal chemohypertermic (IPCH) perfusion combined with Ramirez's abdominoplastic technique in selected patients with voluminous ventral hernias.At the same time, we support the hypothesis that Ramirez' technique would allow a normal intra-abdominal pressure leading to an optimal capability of penetration of chemotherapeutic agents in IPCH.From January 1998 to December 2003, 30 patients were submitted to a surgical debulking and IPCH through a laparotomic approach involving a ventral hernia. After extensive cytoreductive surgery, we closed the large abdominal wall damage with Ramirez's abdominoplasty technique, followed by IPCH. The technique described by Ramirez uses bilateral muscle flap complexes transposed medially to reconstruct the central abdominal wall without using meshes to supply or reinforce the abdominal reconstruction.A total of 23 patients (76.7%) were completely cytoreducted and subjected to IPCH. Postoperative mortality was 1/30 (3.3%). Major morbidity was 5/30 (16.7%). After a mean follow-up of 3 years, no sign of recurrent ventral hernia was noted in the survivors.This study suggests that surgical debulking combined with IPCH is feasible in patients with a previously large abdominal wall defect using the functional Ramirez's abdominoplasty technique. The reconstructive technique allows a regular IPCH procedure without recurrence of the ventral hernia confirmed by clinical examination and abdominal computed tomography.