Alyami M, Passot G, Voiglio E, Lundberg P W, Valette P J, Muller A, Caillot J L
Department of Oncologic, General & Emergency Surgery, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Pierre Bénite, France.
King Abdullah Scholarship Program, Saudi Arabian Cultural Bureau, Paris, Paris, France.
World J Surg. 2015 Dec;39(12):2878-84. doi: 10.1007/s00268-015-3206-2.
Large incisional hernias with loss of domain (LIHLD) of the abdominal wall remain a therapeutic challenge due to the difficulty of replacing the contents of the hernia sac into the peritoneal cavity. Preoperative progressive pneumoperitoneum (PPP) is a valuable option. The purpose of this study was to evaluate the feasibility of peritoneal catheter insertion under ultrasound guidance for PPP and to compare the morbidity and mortality of this new technique to previously used techniques in our department.
Medical records were reviewed retrospectively from February 1989 to April 2013 in a single institution. Three different techniques of PPP were evaluated: surgical subcutaneous implantable port (SIP), surgical peritoneal dialysis catheter (PDC), and radiologic multipurpose drainage catheter (MDC). Collected data included patients' age, sex, body mass index, medical and surgical history, hernia location, PPP technique, length of hospitalization, volume of air injected, morbidity and mortality linked to PPP, and the procedure of hernia repair.
Thirty-seven patients with a mean age of 63.1 years were evaluated. Progressive preoperative pneumoperitoneum was performed using SIP, PDC, and MDC for 14, 11, and 12 patients, respectively. Overall morbidity related to the technique was seen in 36 % of SIP, 27 % of PDC, and 0 % of MDC. One patient from the SIP group died on the 3rd postoperative day due to septic shock following aspiration pneumonia. No postoperative mortality in the other groups was observed.
The MDC is an interesting modification of the original technique and is a safe procedure. It is a minimally invasive technique with a very low risk of perforation of the viscera. Therefore, the use of a non-absorbable prosthesis with MDC technique can be offered for all patients undergoing PPP without increasing the risk of infection.
由于难以将疝囊内容物回纳入腹腔，腹壁巨大切口疝伴腹壁缺损（LIHLD）仍然是一个治疗难题。术前渐进性气腹（PPP）是一种有价值的选择。本研究的目的是评估超声引导下插入腹膜导管进行PPP的可行性，并将这项新技术的发病率和死亡率与我们科室以前使用的技术进行比较。
回顾性分析1989年2月至2013年4月在单一机构的医疗记录。评估了三种不同的PPP技术：手术皮下植入端口（SIP）、手术腹膜透析导管（PDC）和放射学多功能引流导管（MDC）。收集的数据包括患者的年龄、性别、体重指数、病史和手术史、疝的位置、PPP技术、住院时间、注入空气量、与PPP相关的发病率和死亡率以及疝修补手术。
评估了37例平均年龄为63.1岁的患者。分别使用SIP、PDC和MDC对14例、11例和12例患者进行了术前渐进性气腹。与该技术相关的总体发病率在SIP组为36%，PDC组为27%，MDC组为0%。SIP组的1例患者在术后第3天因吸入性肺炎后发生感染性休克死亡。其他组未观察到术后死亡。
MDC是对原始技术的一种有趣改进，是一种安全的手术。它是一种微创手术，内脏穿孔风险非常低。因此，对于所有接受PPP的患者，可以在不增加感染风险的情况下使用不可吸收假体与MDC技术。
