López Sanclemente María Clara, Robres Joaquim, López Cano Manuel, Barri Joan, Lozoya Roberto, López Sergio, Vasco M Angeles, Buqueras M Carmen, Subirana Helena, Jorba Rosa
Servicio de Cirugía General y del Aparato Digestivo, Hospital General de L'Hospitalet Consorci Sanitari Integral, Hospitalet del Llobregat, Barcelona, España.
Cir Esp. 2013 Aug-Sep;91(7):444-9. doi: 10.1016/j.ciresp.2012.08.004. Epub 2013 Mar 6.
Patients with giant hernias with loss of domain require proper planning of surgical repair, because of the high associated comorbidity. The progressive preoperative pneumoperitoneum technique described by Goñi Moreno allows a more physiological adaptation of the patient and the abdominal cavity to the reinstatement of the viscera to the abdomen, enabling adequate surgical repair. The objective of this study was to analyze our experience in the treatment of this type of hernia.
We carried out a retrospective study that included 11 patients with major abdominal wall defects and loss of domain who were treated with this technique in 2 centers between 2005 and 2010.
Eight patients had abdominal hernias and 3 had inguinal hernias. The average insufflation time was 2 weeks and the total amount of air was between 6.6 and 18 l. In 2 patients who showed pulmonary disease decompensation, insufflation had to be temporarily postponed. A further 2 patients had subcutaneous emphysema during the last few days of insufflation, which resolved spontaneously without sequelae. The open mesh repair technique was used in ventral hernias and the preperitoneal technique in all inguinal hernias. There was one recurrence during the 1-year follow-up.
Goñi Moreno's technique remains safe to prepare patients with giant hernias with loss of domain. This procedure can reduce the morbidity caused by the increase in abdominal pressure after abdominal wall repair.
巨大疝且存在腹腔内容物复位困难的患者，因其合并症发生率高，需要对手术修复进行妥善规划。戈尼·莫雷诺描述的渐进性术前气腹技术能使患者和腹腔更生理地适应将内脏复位至腹腔，从而实现充分的手术修复。本研究的目的是分析我们在治疗这类疝方面的经验。
我们进行了一项回顾性研究，纳入了2005年至2010年间在2个中心接受该技术治疗的11例具有严重腹壁缺损且存在腹腔内容物复位困难的患者。
8例患者为腹疝，3例为腹股沟疝。平均充气时间为2周，空气总量在6.6至18升之间。2例出现肺部疾病失代偿的患者，不得不暂时推迟充气。另外2例患者在充气的最后几天出现皮下气肿，气肿自行消退，未留下后遗症。腹疝采用开放补片修补技术，所有腹股沟疝采用腹膜前技术。在1年的随访中有1例复发。
戈尼·莫雷诺技术对于准备接受巨大疝且存在腹腔内容物复位困难的患者而言仍然是安全的。该手术可降低腹壁修复后腹压增加所导致的发病率。
