Complications related to the prehabilitation with preoperative pneumoperitoneum in loss of domain hernias: our experience in 180 consecutive cases

• Published in: Hernia : the journal of hernias and abdominal wall surgery Vol. 28; no. 5; pp. 1591 - 1598
• Main Authors: Bueno-Lledó, J., Martínez-Hoed, J., Bonafé-Diana, S., García-Pastor, P., Torregrosa-Gallud, A., Pareja-Ibars, V., Carreño-Sáenz, O., Pous-Serrano, S.
• Format: Journal Article
• Language: English
• Published: Paris Springer Paris 01-10-2024; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Atrophy; Botulinum toxin; Catheters; Computed tomography; Emphysema; Female; Hematoma; Hernia; Hernia, Ventral - surgery; Hernias; Herniorrhaphy - adverse effects; Herniorrhaphy - methods; Humans; Incisional Hernia - etiology; Incisional Hernia - prevention & control; Incisional Hernia - surgery; Male; Medicine; Medicine & Public Health; Middle Aged; Original Article; Peritoneum; Pneumoperitoneum, Artificial - adverse effects; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Preoperative Care - methods; Preoperative Exercise; Retrospective Studies; Small intestine; Subcutaneous Emphysema - etiology; Subcutaneous Emphysema - prevention & control; Hernia; Abdominal wall surgery; Prehabilitation; Complications; Hernia surgery; Progressive preoperative pneumoperitoneum; Abdominal wall hernia repair; Botulinum toxin; Optimization
• ISSN: 1248-9204; 1265-4906; 1248-9204
• DOI: 10.1007/s10029-023-02836-6

Objective
Progressive pneumoperitoneum (PPP) is useful tool in the preparation of patients with loss of domain hernias (LODH). The purpose of this observational retrospective study was to report our experience in the management of complications associated with the PPP procedure after treating 180 patients with LODH and to report preventive measures to avoid them.
Methods
Of the 971 patients with a ventral incisional hernia operated on between June 2012 and July 2022, 180 consecutive patients with LODH were retrospectively analysed. Diameters of abdominal cavity, and volumes of incisional hernia and abdominal cavity were calculated from CT scan, based on the modified index of Tanaka. Complications related to the PPP procedure (catheter placement and following insufflations of air) were recorded by Clavien–Dindo classification.
Results
Complications associated to PPP were 26.6%. No complications occurred during the administration of botulinum toxin (BT). Eighteen patients (10% of 180 patients) developed subcutaneous emphysema during the last days of the insufflations; there were 2 accidental perforations of the small bowel and four punctures with liver and splenic hematomas, detected during catheter placement; a laparotomy, however, was not needed because it was solved with conservative treatment. We diagnosed it as a peritoneum-cutaneous fistula due to the cutaneous atrophy secondary to chronic eventration.
Conclusion
PPP is a safe technique well tolerated by patients, although at the cost of some specific complications. Hernia surgeons must understand these complications to prevent them and to inform the LODH patient about their existence.