ON-TABLE PNEUMOPERITONEUM IN THE MANAGEMENT OF COMPLICATED INCISIONALHERNIAS

'On-table' pneumoperitoneum before repair of 'complicated' incisional hernias has been used in eight patients considered to be at high risk of recurrence. In four patients the procedure revealed the presence of occult defects. The procedure was uncomplicated and a primary repair without the need for a prosthetic implant was possible in all cases. S ix patients remain well with no sign of recurrence at a median follow- up of 96 months (range 22-120 months). Two patients died from conditio ns unrelated to the method of repair; acute necrotising pancreatitis o n the 10th postoperative day and lobar pneumonia 2 months postoperativ ely. Peroperative pneumoperitoneum is a simple procedure which obviate s the need for a prosthetic implant in selected patients. It is theref ore particularly useful in the management of incisional hernias associ ated with sepsis, stomas or in patients requiring synchronous bowel re section.