Preoperative Progressive Pneumoperitoneum Enables Defect Closure and Laparoscopic Repair of Large Parastomal Hernias

Abstract

Purpose: Preoperative progressive pneumoperitoneum (PPP) has not been reported in the management of parastomal hernias; therefore, the present study evaluated its effectiveness in the surgical management of large parastomal hernias. Patients and Methods: This prospective, observational study included 23 consecutive patients with large parastomal hernias who underwent PPP between January 2016 and September 2018. The volume of parastomal hernia (VPH), volume of the abdominal cavity (VAC), and the VPH/VAC ratio were measured before and after PPP using abdominal computed tomography scan data. All the hernias were repaired by a laparoscopic or laparoscopic-open-laparoscopic approach using the intraperitoneal Sugarbaker technique. Results: Before and after PPP, the mean VPH was 1442 and 1581 mL (P<0.01), and the mean VAC was 5667 and 9194 mL (P<0.01). The VAC increased by 3527 mL (P<0.01) and was greater than the mean VPH before PPP. The VPH/VAC ratio after PPP was reduced at an average of 8.1% (P<0.01). Fascial closure was achieved in all patients, with no clinical evidence of elevated intra-abdominal pressures. The mean follow-up was 24 months (13 to 40 mo), and, to date, no hernia recurrences have been reported in these patients. Conclusions: PPP is a feasible and useful tool in the surgical management of large parastomal hernias. It passively expands the abdominal volumes, thereby resulting in respiratory adaptation to elevated intra-abdominal pressures.

End-colostomy parastomal hernia repair: a systematic review on laparoscopic and robotic approaches

“…Direct comparison of repair longevity between LPHR and OPHR with mesh using Kaplan–Meier estimation is unique to this study. Further studies are needed to better understand the methods of parastomal hernia repair associated with minor complications and increased duration F. Tang [ 50 ] 2020 Prospective, observational study 16 Rectectomy (Mile surgery) (16), Colectomy (5), Radical cystectomy (1), Traumatic intestinal rupture (1) Sugarbaker technique Colostomy (16), Ileostomy (6), Ileal orthotopic neobladder (1) 11 Composite-polyester mesh (PCO-PM 20) Intraperitoneal Dyspnea (1), seroma (1), intestinal obstruction (2), urinary infection (2), wound infection (1) 24 0 PPP causes a significant increase in abdominal volumes preoperatively, thereby facilitating the total reintegration of the bowel into the abdominal cavity. Through the progressive increase of VAC, PPP induces respiratory adaptation to the elevat ed intra-abdominal pressure following hernia repair A. G. Barranquero [ 36 ] 2023 Retrospective dual-center observational study 38 Sigmoidectomy (3), low anterior resection (12), abdominoperineal resection (21) Sandwich technique Loop colostomy (2), end colostomy (36) 11 TiMesh ® (29), DynaMesh ® IPOM (9) Intraperitoneal Seroma (15), Surgical site infection (2), Hematoma (3), Postoperative ileus (1) 39 3 The recurrence rates observed in the sandwich technique were in line with the rates documented in the current literature.…”

Tension-free hiatal hernia repair with biological mesh: A real-world experience

“…This study adopted a 7-step surgical procedure. [ 12 ] After radiography exhibited partial hernia of gastric fundus into esophageal hiatus (Fig. 1 A and B), the patient was placed in a supine position with both lower limbs abducted and the head 30-degrees higher than the feet, with the operator standing between the patient’s legs.…”

Fascial closure in giant ventral hernias after preoperative botulinum toxin a and progressive pneumoperitoneum: A systematic review and meta-analysis

“…Loss of domain ratio >20% or >25% 22,24,25,35 Measurements (hernia width or loss of domain ratio) 14,21,32,34,35 Hernia width >10 cm 23,30 Hernia width cut-off þ loss of domain ratio >20% 14,21 Surgeon preference or expected difficulty closing midline 11,27 Hernia contents cannot be reduced back to abdominal cavity 26 Foreseen problems during surgery 29 Open abdomen 12,28 Undefined/surgeon's decision 10,31,33,36 BT, Botulinum Toxin A; cm, centimeter; PP, progressive pneumoperitoneum.…”