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Hernia
Published in: Hernia 2/2017

01-04-2017 | Original Article

Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia

Authors: J. Bueno-Lledó, A. Torregrosa, N. Ballester, O. Carreño, F. Carbonell, P. G. Pastor, J. Pamies, V. Cortés, S. Bonafé, J. Iserte

Published in: Hernia | Issue 2/2017

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Abstract

Purpose

Combination of preoperative progressive pneumoperitoneum (PPP) and botulinum toxin type A (BT) has not been previously reported in the management of large incisional hernia (LIH).

Methods

Observational study of 45 consecutive patients with LIH between June 2010 and July 2014. The diameters of the hernia sac, the volumes of the incisional hernia (VIH) and the abdominal cavity (VAC), and the VIH/VAC ratio were measured before and after PPP and BT using abdominal CT scan data. We indicated the combination of both techniques when the volume of the incisional hernia (VIH)/volume of the abdominal cavity (VAC) ratio was >20%.

Results

The median insufflated volume of air for PPP was 8.600 ± 3.200 cc (4.500–13.250), over a period of 14.3 ± 1.3 days (13–16). BT administration time was 40.2 ± 3.3 days (37–44). We obtained an average value of reduction of 14% of the VIH/VAC ratio after PPP and BT (p < 0.05). Complications associated with PPP were 15.5%, and with surgical technique, 26.6%. No complications occurred during the BT administration. Reconstructive technique was anterior CST and primary fascial closure was achieved in all patients. Median follow-up was 40.5 ± 19 months (12–60) and we reported 2 cases of hernia recurrence (4.4%).

Conclusions

Preoperative combination of PPP and BT is feasible and a useful tool in the surgical management of LIH, although at the cost of some specific complications.

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Metadata
Title
Preoperative progressive pneumoperitoneum and botulinum toxin type A in patients with large incisional hernia
Authors
J. Bueno-Lledó
A. Torregrosa
N. Ballester
O. Carreño
F. Carbonell
P. G. Pastor
J. Pamies
V. Cortés
S. Bonafé
J. Iserte
Publication date
01-04-2017
Publisher
Springer Paris
Published in
Hernia / Issue 2/2017
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-017-1582-2

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