Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
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

Login to get access

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.
Appendix
Available only for authorised users
Literature
1.
Klinge U, Conze J, Krones C, Schumpelick V (2005) Incisional hernia: open techniques. World J Surg 29:1066–1072CrossRefPubMed
2.
Quarishi AH, Borkar MM, Mastud MM, Jannawar GG (2013) Preoperative progressive pneumoperitoneum for repair of a large incisional hernia. Updates Surg 65:165–168CrossRef
3.
Breuing K, Butler CE, Ferzoco S (2010) Incisional ventral hernias: review of the literature and recommendations regarding the grading and technique of repair. Surgery 148:544–558CrossRefPubMed
4.
Hendrikus J, van Geffen Roger K (2005) Incisional hernia repair: abdominoplasty. Tissue expansion and methods of augmentation. World J Surg 29:1080–1085CrossRef
5.
Goñi-Moreno I (1947) Chronic eventrations and large hernias: preoperative treatment by progressive pneumoperitoneum—original procedure. Surgery 22:945–953
6.
Dumont F, Fuks D, Verhaeghe P, Brehant O, Sabbagh C, Riboulot M et al (2009) Progressive pneumoperitoneum increases the length of abdominal muscles. Hernia 13:183–187CrossRefPubMed
7.
Chávez K, Cárdenas LE, Pérez-Trigos H (2014) Resultado de la aplicación preoperatoria de toxina botulínica A en el tratamiento de hernias incisionales gigantes. Rev Hispanoam Hernia 2:145–151CrossRef
8.
Ibarra-Hurtado TR, Nuño-Guzmán CM, Echeagaray-Herrera JE, Robles-Velez E, de Jesus Gonzalez-Jaime J (2009) Use of botulinum toxin type a before abdominal wall hernia reconstruction. World J Surg 33:2553–2556CrossRefPubMed
9.
Zielinski M, Goussous N, Schiller H (2013) Chemical components separation with botulinum toxin A: a novel technique to improve primary fascial closure rates of the open abdomen. Hernia 17:101–107CrossRefPubMed
10.
Deerenberg EB, Timmermans L, Hogerzeil DP, Slieker JC, Eilers PH, Jeekel J et al (2015) A systematic review of the surgical treatment of large incisional hernia. Hernia 19:89–101CrossRefPubMed
11.
Slater NJ, Montgomery A, Berrevoet F et al (2014) Criteria for definition of a complex abdominal wall hernia. Hernia 18:7–17CrossRefPubMed
12.
Tanaka EY, Yoo JH, Rodrigues AJ Jr, Ultiyama EM, Birolini D, Rasslan S (2010) Computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia 14:63–69CrossRefPubMed
13.
Zendejas B, Khasawneh M, Srvantstyan B, Jenkins DH, Schiller HJ, Zielinski MD (2013) Outcomes of chemical component paralysis using botulinum toxin for incisional hernia repairs. World J Surg 37:2830–2837CrossRefPubMed
14.
Carbonell F, Bonafé S, García P, Gomez I, Baquero R (2009) Nuevo método de operar en la eventración compleja: separación anatómica de componentes con prótesis y nuevas inserciones musculares. Cir Esp 86:87–93CrossRef
15.
Carbonell F, Garcia P, Bueno J (2011) Tratamiento de la eventración subxifoidea: técnica de doble malla ajustada al defecto. Cir Esp 89:370–378CrossRef
16.
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral
17.
Muysoms FE, Miserez M, Berrevoet F, Campanelli G, Champault GG, Chelala E et al (2009) Classification of primary and incisional abdominal wall hernias. Hernia 13:407–414CrossRefPubMedPubMedCentral
18.
Mayagoitia JC, Suarez D, Arenas JC, Diaz de Leon V (2006) Preoperative progressive pneumoperitoneum in patients with abdominal-wall hernias. Hernia 10:213–217CrossRefPubMed
19.
Lopez MC, Robres J, Lopez Cano M (2013) Neumoperitoneo preoperatorio progresivo en pacientes con hernias gigantes de la pared abdominal. Cir Esp 91:444–449CrossRefPubMed
20.
Sabbagh C, Dumont F, Fuks D, Yzet T, Vernaeghe P, Regimbeau JM (2012) Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study. Hernia 16:33–40CrossRefPubMed
21.
Caldironi MW, Romano M, Bozza F, Pluchinotta AM, Pelizzo MR, Toniato A et al (1990) Progressive pneumoperitoneum in the management of giant incisional hernias: a study of 41 patients. Br J Surg 77:306–307CrossRefPubMed
22.
Minossi JG, Oliveira WK, Llanos JC, Ielo SM, Hasimoto CN, Pereira RS et al (2009) Preoperative progressive pneumoperitoneum in voluminous abdominal wall hernias. Arq Gastroenterol 46:121–126CrossRefPubMed
23.
Mcadory RS, Cobb WS, Carbonell AM (2009) Progressive preoperative pneumoperitoneum for hernias with loss of domain. Am Surg 75:504–508PubMed
24.
Coelho JC, Brenner AS, Freitas AT, Campos AC, Wiederkehr JC (1993) Progressive preoperative pneumoperitoneum in the repair of large abdominal hernias. Eur J Surg 159:339–341PubMed
25.
Luder PJ, Haller BG, Gertsch P, Blumgart LH, Lerut JP (1990) Pneumoperitoneum and Mersilene mesh in the treatment of giant abdominal wall hernias. Helv Chir Acta 56:927–930PubMed
26.
Pamies J, Aboud C, Navarro V (2013) La valoración cualitiativa y cuantitativa de la hernia abdominal con tomografía computarizada multidetector. Rev Hispanoam Hernia 1:149–158CrossRef
27.
Sabbagh C, Dumont F, Robert B, Badaoui R, Verhaehe P, Regimbeau JM (2011) Peritoneal volume is predictive of tensionfree fascia closure of large incisional hernias with loss of domain: a prospective study. Hernia 15:559–565CrossRefPubMed
28.
Martinez Munive A, Quijano F, Padilla R (2002) Catéter de doble luz para neumoperitoneo en hernias gigantes. Informe de cuatro pacientes. Cirujano General 24:313–318
29.
Cakmak M, Caglayan F, Somuncu S, Leventoglu A, Ulusoy S, Akman H (2006) Effect of paralysis of the abdominal wall muscles by botulinum A toxin to intraabdominal pressure: an experimental study. J Pediatr Surg 41:821–825CrossRefPubMed
30.
Ibarra-Hurtado T, Nuño-Guzman C, Miranda AG, Troyo R, Navarro R, Bravo L (2014) Effect of botulinum toxin type A in lateral abdominal wall muscles thickness and length of patients with midline incisional hernia secondary to open abdomen management. Hernia 18:647–652CrossRefPubMed
31.
Walker HW, Lee MY, Bahroo LB, Hedera P, Charles D (2015) Botulinum toxin injection techniques for the management of adult spasticity. PMR 7:417–427CrossRef
32.
Ploumis A, Varvarousis D, Konitsiotis S, Beris A (2014) Effectiveness of botulinum toxin injection with and without needle electromyographic guidance for the treatment of spasticity in hemiplegic patients: a randomized controlled trial. Disabil Rehabil 36:313–318CrossRefPubMed
33.
Muysoms FE, Antoniou SA, Bury K, Campanelli G, Conze J, Cuccurullo D et al (2015) European Hernia Society guidelines on the closure of abdominal wall incisions. Hernia 19:1–24CrossRefPubMed
34.
Ramirez OM, Ruas E, Dellon AL (1990) “Components separation” method for closure of abdominal wall defects: an anatomic and clinical study. Plast Reconstr Surg 86:519–526CrossRefPubMed
35.
Novitsky YW, Elliott HL, Orenstein SB, Rosen MJ (2012) Transversus abdominis muscle release: a novel approach to posterior component separation during complex abdominal wall reconstruction. Am J Surg 204:709–716CrossRefPubMed
36.
Jones CM, Winder JS, Potochny JD, Pauli EM (2016) Posterior component separation with transversus abdominis release: technique, utility, and outcomes in complex abdominal wall reconstruction. Plast Reconstr Surg 137:636–646CrossRefPubMed
37.
Pauli EM, Wang J, Petro CC, Juza RM, Novitsky YW, Rosen MJ (2015) Posterior component separation with transversus abdominis release successfully addresses recurrent ventral hernias following anterior component separation. Hernia 19:285–291CrossRefPubMed
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

Other articles of this Issue 2/2017

Hernia 2/2017 Go to the issue

Original Article

Ventral hernia repair in patients with abdominal loss of domain: an observational study of one institution’s experience

Original Article

Internal hernia following laparoscopic colorectal surgery: a rare but fatal complication

TRIBUTE

Tribute to Professor Andrew Kingsnorth

Original Article

Risk factors for injuries associated with damage claims following groin hernia repair

Original Article

The Open Abdomen Route by EuraHS: introduction of the data set and initial results of procedures and procedure-related complications

Review

Parastomal hernia following cystectomy and ileal conduit urinary diversion: a systematic review