• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
  • Skip to footer

SAGES

Reimagining surgical care for a healthier world

  • Home
    • COVID-19 Annoucements
    • Search
    • SAGES Home
    • SAGES Foundation Home
  • About
    • Who is SAGES?
    • SAGES Mission Statement
    • Advocacy
    • Strategic Plan, 2020-2023
    • Committees
      • Request to Join a SAGES Committee
      • SAGES Board of Governors
      • Officers and Representatives of the Society
      • Committee Chairs and Co-Chairs
      • Full Committee Rosters
      • SAGES Past Presidents
    • Donate to the SAGES Foundation
    • Awards
      • George Berci Award
      • Pioneer in Surgical Endoscopy
      • Excellence In Clinical Care
      • International Ambassador
      • IRCAD Visiting Fellowship
      • Social Justice and Health Equity
      • Excellence in Community Surgery
      • Distinguished Service
      • Early Career Researcher
      • Researcher in Training
      • Jeff Ponsky Master Educator
      • Excellence in Medical Leadership
      • Barbara Berci Memorial Award
      • Brandeis Scholarship
      • Advocacy Summit
      • RAFT Annual Meeting Abstract Contest and Awards
  • Meetings
    • NBT Innovation Weekend
    • SAGES Annual Meeting
      • 2023 Scientific Session Call For Abstracts
      • 2023 Emerging Technology Call For Abstracts
    • CME Claim Form
    • Industry
      • Advertising Opportunities
      • Exhibit Opportunities
      • Sponsorship Opportunities
    • Future Meetings
    • Past Meetings
      • SAGES 2022
      • SAGES 2021
    • Related Meetings Calendar
  • Join SAGES!
    • Membership Benefits
    • Membership Applications
      • Active Membership
      • Affiliate Membership
      • Associate Active Membership
      • Candidate Membership
      • International Membership
      • Medical Student Membership
    • Member News
      • Member Spotlight
      • Give the Gift of SAGES Membership
  • Patients
    • Healthy Sooner – Patient Information for Minimally Invasive Surgery
    • Patient Information Brochures
    • Choosing Wisely – An Initiative of the ABIM Foundation
    • All in the Recovery: Colorectal Cancer Alliance
    • Find a SAGES Member
  • Publications
    • SAGES Stories Podcast
    • SAGES Clinical / Practice / Training Guidelines, Statements, and Standards of Practice
    • Patient Information Brochures
    • TAVAC – Technology and Value Assessments
    • Surgical Endoscopy and Other Journal Information
    • SAGES Manuals
    • SCOPE – The SAGES Newsletter
    • COVID-19 Annoucements
    • Troubleshooting Guides
  • Education
    • OpiVoid.org
    • SAGES.TV Video Library
    • Safe Cholecystectomy Program
      • Safe Cholecystectomy Didactic Modules
    • Masters Program
      • SAGES Facebook Program Collaboratives
      • Acute Care Surgery
      • Bariatric
      • Biliary
      • Colorectal
      • Flexible Endoscopy (upper or lower)
      • Foregut
      • Hernia
      • Robotics
    • Educational Opportunities
    • HPB/Solid Organ Program
    • Courses for Residents
      • Advanced Courses
      • Basic Courses
    • Video Based Assessments (VBA)
    • Robotics Fellows Course
    • MIS Fellows Course
    • Facebook Livestreams
    • Free Webinars For Residents
    • SMART Enhanced Recovery Program
    • SAGES OR SAFETY Video
    • SAGES at Cine-Med
      • SAGES Top 21 MIS Procedures
      • SAGES Pearls
      • SAGES Flexible Endoscopy 101
      • SAGES Tips & Tricks of the Top 21
  • Opportunities
    • NEW-Area of Concentrated Training Seal (ACT)-Advanced Flexible Endoscopy-Coming Soon!
    • SAGES Fellowship Certification for Advanced GI MIS and Comprehensive Flexible Endoscopy
    • Multi-Society Foregut Fellowship Certification
    • SAGES Research Opportunities
    • Fundamentals of Laparoscopic Surgery
    • Fundamentals of Endoscopic Surgery
    • Fundamental Use of Surgical Energy
    • Job Board
    • SAGES Go Global: Global Affairs and Humanitarian Efforts
  • Search
    • Search All SAGES Content
    • Search SAGES Guidelines
    • Search the Video Library
    • Search the Image Library
    • Search the Abstracts Archive
  • Store
    • “Unofficial” Logo Products
  • Log In

Progressive preoperative pneumoperitoneum complementing chemical component relaxation in complex ventral hernia repair: benefits and complications

Kristen E Elstner, MBBS1, Anita S Jacombs, MBBS, PhD2, John W Read, FRANZCR3, Michael Edye, FRACS4, Nabeel Ibrahim, FRACS5. 1Macquarie University Hospital, Sydney, Australia, 2Faculty of Medicine & Health Sciences, Macquarie University, Australia, 3Castlereagh Imaging, St Leonards, Australia, 4Professor of Surgery and Chair, University of Western Sydney, 5Hernia Insitutue Australia, Edgecliff, Australia

Introduction: Repair of complex ventral hernia, and particularly those with large defects suffering significant loss of domain, is a challenging situation for any surgeon. Closure of large defects is fraught with possible complications, such as dehiscence, impaired venous return, organ dysfunction, and impaired ventilation. First described in 1947, Progressive Preoperative Pneumoperitoneum (PPP) is a technique designed to expand the capacity of the abdominal cavity, thereby facilitating fascial closure at time of operation and reducing the risk of raised intra-abdominal pressures and its sequelae. We present a series of patients treated with PPP, along with chemical component relaxation, prior to elective laparoscopic repair of complex ventral hernia.

Methods: A series of 13 patients with loss of domain greater than 20% underwent short term PPP prior to elective repair of ventral hernia. A 6Fr peritoneal catheter was inserted into the left upper quadrant (or where feasible) 7-10 days preoperatively, with progressive insufflation of air into the peritoneal cavity. Insufflation was dictated by patient tolerance, averaging 800-1000 mls every second day. Patients were monitored clinically as well as radiologically, with serial non-contrast abdominal CT imaging. Patients then proceeded to laparoscopic or laparoscopic-assisted repair of their ventral hernia.

Results: Between 2013 and 2015, PPP was performed in 13 patients. Defect size averaged 237 cm2 (range 34 – 459) with loss of domain ranging between 20 to 41%. Mean patient age 55, and mean BMI was 32 kg/m2 (range 22 – 46). All patients had multiple previous abdominal operations and failed ventral hernia repairs.

Complications included surgical emphysema (n = 2, 15.3%), pneumothorax (n = 3, 23.1%), pneumomediastinum (n = 3, 23.1%), and metabolic acidosis (n= 1, 7.7%). No bowel perforations occurred.

All patients proceeded to successful laparoscopic or laparoscopic-assisted repair of ventral hernia. Fascial closure was feasible in all patients.

Conclusions: PPP is a rarely utilized adjunct in complex abdominal hernia surgery, despite many successful anecdotal reports in the literature. The literature states that PPP delivers pneumatic expansion of the abdominal wall, but in fact may be demonstrating the difference between unstretched versus stretched abdominal wall (without actual expansion). In our experience, the main advantage of PPP is in post- insufflation imaging, which can identify sites on the abdominal wall which are safe to use as an access point into the previously operated-on abdomen. Its benefits, however, must be weighed with its pitfalls: risk of complications such as pneumothorax, pneumomediastinum, and metabolic acidosis.

810

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Pinterest
  • WhatsApp
  • Reddit

Related

« Return to SAGES 2016 abstract archive

Our Mission

Innovate, educate and collaborate to improve patient care.

Recently, on SAGES…

Critical View of Safety (CVS) Challenge QR Code

The SAGES Critical View of Safety Challenge – Donate Your Lap Chole Videos!

The Society of American Gastrointestinal and Endoscopic Surgeons is hosting the first Artificial Intelligence Data Challenge conducted by surgeons. The aim of this challenge is to generate a large and diverse dataset of laparoscopic cholecystectomy videos, annotated with respect to the subcomponents of the Critical View of Safety (CVS). Computer scientists from all over the […]

Respuesta de SAGES al Estudio NordICC sobre el beneficio de las colonoscopias de detección

SAGES desea aclarar los resultados del estudio NordICC y colocarlos en contexto de los esfuerzos de varias agencias nacionales para reducir el riesgo de cáncer colorrectal – la segunda causa de muerte por cáncer más frecuente en los Estados Unidos-, mediante la promoción de la detección y tratamiento oportuno de las lesiones.

SAGES Response to NordICC Study Regarding Benefit of Screening Colonoscopies

The NordICC Study recently published in The New England Journal of Medicine and widely reported on by media outlets has raised questions regarding the benefit of screening colonoscopy in lowering the risk of colorectal cancer and cancer-related deaths among otherwise healthy and symptom-free men and women aged 55 to 64. Provocative headlines and commentaries have […]

Contact SAGES

Society of American Gastrointestinal and Endoscopic Surgeons
11300 W. Olympic Blvd Suite 600
Los Angeles, CA 90064 USA
webmaster@sages.org
Tel: (310) 437-0544

Find Us Around the Web!

  • Facebook
  • Twitter
  • YouTube

Important Links

SAGES 2023 Meeting Information

Healthy Sooner: Patient Information

SAGES Guidelines, Statements, & Standards of Practice

SAGES Manuals

 

  • taTME Study Info
  • Foundation
  • SAGES.TV
  • MyCME
  • Educational Activities

Copyright © 2023 Society of American Gastrointestinal and Endoscopic Surgeons