PROGRESSIVE PREOPERATIVE PNEUMOPERITONEUM IN THE REPAIR OF LARGE ABDOMINAL-HERNIAS

Objective: To present our experience of progressive preoperative pneum operitoneum 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 o f the 252 who presented for abdominal hernia repair between January 19 77 and April 1992. Interventions: Air was insufflated into the periton eal cavity through a 19 gauge spinal needle, and between 500 and 2000 ml was usually injected at the first session. Amounts were gradually i ncreased 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 outco me measures: Whether the hernia could be repaired directly without rec ourse to polypropylene mesh, complications of pneumoperitoneum, and re currence rate. Results: In one patient air was insufflated into the co lon, one developed temporary but severe respiratory distress, and 4 de veloped moderate subcutaneous emphysema. 30 hernias were repaired dire ctly, and 6 required polypropylene mesh. There were three wound infect ions (two after direct repair), and two recurrences (both after direct repair). Mean length of follow up was 10 months (range 1-48). Conclus ion: Progressive preoperative pneumoperitoneum allows direct repair of some large abdominal hernias with a low recurrence rate, and few comp lications.