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Anales de la Facultad de Ciencias Médicas (Asunción)

versão impressa ISSN 1816-8949


CUENCA TORRES, O  e  HOSPITAL DE CLINICAS. FACULTAD DE CIENCIAS MEDICAS. UNIVERSIDAD NACIONAL DE ASUNCION. Segunda Cátedra de Clínica Quirúrgica et al. Application of progressive preoperative pneumoperitoneum in parietal complex conditions. An. Fac. Cienc. Méd. (Asunción) [online]. 2013, vol.46, n.2, pp.35-44. ISSN 1816-8949.

ABSTRACT Introduction: The technique of progressive preoperative pneumoperitoneum, based on insufflating the abdominal cavity with air, has been introduced to manage complex hernias. Objective: Describe the technique results in complex hernias of abdominal wall. Patients and methods: A descriptive study of 32 patients with complex hernias and implementing progressive preoperative pneumoperitoneum in the Second Surgical Clinic Chair from January 2008 to April 2014. Results: 32 patients, 14 women and 18 men, average age 58±(40-76) years. Most common pathologies found: arterial hypertension and obesity. Types of parietal affections: 10 incisional hernias, 9 inguinoscrotal hernias, 3 epigastric hernias, and 3 healed open ventral hernias (seven with stomas). Duration of the progressive preoperational pneumoperitoneum, inguinoscrotal hernias was 9,8±(2-16 days); incisional hernias and healed opened ventral 13,5±(5-29 days). Complications of the progressive pneumoperitoneum 10 (31,2%): omalgia (2), respiratory difficulty (3), infection where the catheter was placed (1), subcutaneous emphysema by exit of the catheter (2), intestinal occlusion (2). average environmental air insufflated: 10,08liters ±(1,4-25,7liters). Parietal treatment: Inguinoscrotal hernias (9): Plugstein technique (9). Epigastric hernias (3): Rives technique (1) and Onlay mesh collocation (2). Incisional hernias (10): Rives technique (2), Ramirez technique (3), and Onlay mesh collocation (5). Healed opened ventral hernias (10): Ramirez technique(8), Onlay mesh collocation (2), simultaneously with intestinal restitution (7 cases). Surgical timing: 2hours 86min ±(55min-4hours 30min). Postsurgery hospital stay: 5.5±(3 a 8 days). Immediate postoperational complications: A case of lung thromboembolism solved with antithrombotic measures. One patient with seroma, treated with tap-drainage. One death by compartment syndrome. 24 months of follow up with no relapse. Conclusion: The progressive preoperational pneumoperitoneum, in complex hernias produces gradual breathing restriction, giving elasticity and compliance to the abdominal wall with effective results in the surgical repair as well as in the postoperative. Key words: Pneumoperitoneum. Complex hernias. Parietal treatment.

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