Progressive preoperative pneumoperitoneum in the repair of large abdominal hernias.

OBJECTIVE

To present our experience of progressive preoperative pneumoperitoneum in the preparation of patients for repair of large hernias of the abdominal wall.

DESIGN

Prospective selected series.

SETTING

A university hospital and a district hospital.

SUBJECTS

36 Patients of the 252 who presented for abdominal hernia repair between January 1977 and April 1992.

INTERVENTIONS

Air was insufflated into the peritoneal cavity through a 19 gauge spinal needle, and between 500 and 2000 ml was usually injected at the first session. Amounts were gradually increased daily or every other day for a period of 6-15 days; the total amount insufflated ranged from 4500-18,500 (mean 7700) ml.

MAIN OUTCOME MEASURES

Whether the hernia could be repaired directly without recourse to polypropylene mesh, complications of pneumoperitoneum, and recurrence rate.

RESULTS

In one patient air was insufflated into the colon, one developed temporary but severe respiratory distress, and 4 developed moderate subcutaneous emphysema. 30 hernias were repaired directly, and 6 required polypropylene mesh. There were three wound infections (two after direct repair), and two recurrences (both after direct repair). Mean length of follow up was 10 months (range 1-48).

CONCLUSION

Progressive preoperative pneumoperitoneum allows direct repair of some large abdominal hernias with a low recurrence rate, and few complications.