V-002 MASSIVE INGUINAL HERNIA REPAIR WITH CHEMICAL COMPONENT RELAXATION AND PREOPERATIVE PROGRESSIVE PNEUMOPERITONEUM

Abstract

Abstract Inguinal hernias are one of the most common procedures performed worldwide. Conversely, massive or giant inguinal hernias; defined as extending below the midpoint of the inner thigh are very uncommon. They are often associated with loss of domain, posing a different set of challenges for the surgeon, specially creating intra-abdominal space for the displaced organs. Preoperative progressive pneumoperitoneum (PPP) coupled with chemical denervation with botulinum toxin A (BTA) is one way to increase the size of the intrabdominal cavity to aid in reduction of the hernia contents and closure of the defect. We present a case of a 51-year-old male with a massive right inguinal hernia with complete loss of domain. The hernia sac contained the entirety of his small bowel and colon except for his proximal duodenum and distal rectum which remained intrabdominal. We preformed preoperative BTA chemical denervation and progressive pneumoperitoneum prior to staged open Inguinal hernia repair. 1 month preoperatively BTA injections were performed under ultrasound guidance into the external and internal obliques at 3 locations bilaterally and an intraabdominal catheter was placed under laparoscopic guidance. The patient was insufflated with filter air 3 times a week for 3 weeks. He then underwent open repair with preperitoneal mesh placed and orchiectomy.