Skip to main content

Advertisement

SpringerLink
Log in

Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Introduction

Progressive preoperative pneumoperitoneum (PPP) is used to prepare incisional hernias with loss of domain (IHLD) operations. The aim of the present study was to analyze the effect of PPP on peritoneal volume [measured using a new computed tomography (CT)-based method] and respiratory function.

Methods

From July 2004 to July 2008, 19 patients were included in a prospective, observational study. The volumes of the incisional hernia (VIH), the abdominal cavity (VAC), the total peritoneal content (VP) and the VIH/VP ratio were measured before and after PPP using abdominal CT scan data. Spirometric parameters were measured before and after PPP, and postoperative clinical data were evaluated.

Results

Before and after PPP, the mean VIH was 1,420 cc and 2,110 cc (P  < 0.01), and the mean VAC was 9,083 cc and 11,104 cc (P < 0.01). The VAC increased by 2,021 cc (P < 0.01) and was greater than the mean VIH before PPP. After PPP, the spirometric measurements revealed a restrictive syndrome. The overall postoperative morbidity rate was 37%.

Conclusions

PPP increased the hernia and abdominal volumes. PPP induced a progressive, restrictive syndrome.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Korenkov M, Paul A, Sauerland S, Neugebauer E, Arndt M, Chevrel JP, Corcione F, Fingerhut A, Flament JB, Kux M, Matzinger A, Myrvold HE, Rath AM, Simmermacher RK (2001) Classification and surgical treatment of incisional hernia. Results of an experts’ meeting. Langenbecks Arch Surg 386:65–73

    Article  PubMed  CAS  Google Scholar 

  2. Rives J, Chevrel JP, Caix M (1987) Surgery of the abdominal wall. In: Rives J, Chevrel JP, Caix M (eds) Hernias and surgery of the abdominal wall. Springer, Berlin, pp 116–143

    Google Scholar 

  3. Dabbas N, Adams K, Pearson K, Royle G (2011) Frequency of abdominal wall hernias: is classical teaching out of date? JRSM Short Rep 2:5

    Article  PubMed  Google Scholar 

  4. Stoppa R, Ralaimiaramanana F, Henry X, Verhaeghe P (1999) Evolution of large ventral incisional hernia repair. The French contribution to a difficult problem. Hernia 3:1–3

    Article  Google Scholar 

  5. Lowe JB 3rd, Lowe JB, Baty JD, Garza JR (2003) Risks associated with “components separation” for closure of complex abdominal wall defects. Plast Reconstr Surg 111:1276–1283

    Article  PubMed  Google Scholar 

  6. Trivellini G, Zanella G, Danelli PG, Pratolongo D, Ferri O (1984) Surgical treatment of large eventrations. Study of a technic adapted to disorders of respiratory compliance. Chirurgie 110:116–122

    PubMed  CAS  Google Scholar 

  7. Munegato G, Grigoletto R, Brandolese R (2000) Respiratory mechanics in abdominal compartment syndrome and large incisional hernias; a study of 41 patients. Hernia 4:282–285

    Article  Google Scholar 

  8. Cady B, Brooke-Cowden GL (1976) Repair of massive abdominal wall defects. Combined use of pneumoperitoneum and Marlex mesh. Surg Clin North Am 56:559–570

    PubMed  CAS  Google Scholar 

  9. Paajanen H, Laine H (2005) Operative treatment of massive ventral hernia using polypropylene mesh: a challenge for surgeon and anesthesiologist. Hernia 9:62–67

    Article  PubMed  CAS  Google Scholar 

  10. Dumont F, Fuks D, Verhaeghe P, Brehant O, Sabbagh C, Riboulot M, Yzet T, Regimbeau JM (2009) Progressive pneumoperitoneum increases the length of abdominal muscles. Hernia 13:183–187

    Google Scholar 

  11. Goni Moreno I (1971) Pneumoperitoneum applied to the surgical preparation of large chronic eventrations. Prensa Med Argent 58:1037–1041

    PubMed  CAS  Google Scholar 

  12. Koontz AR, Graves JW (1954) Preoperative pneumoperitoneum as an aid in the handling of gigantic hernias. Ann Surg 140:759–762

    Article  PubMed  CAS  Google Scholar 

  13. Mayagoitia JC, Suarez D, Arenas JC, Diaz de Leon V (2006) Preoperative progressive pneumoperitoneum in patients with abdominal-wall hernias. Hernia 10:213–217

    Article  PubMed  CAS  Google Scholar 

  14. Forrest J (1979) Repair of massive inguinal hernia: with pneumoperitoneum and without using prosthetic mesh. Arch Surg 114:1087–1088

    Article  PubMed  CAS  Google Scholar 

  15. Stoppa R, Louis D, Verhaeghe P, Henry X, Plachot JP (1987) Current surgical treatment of post-operative eventrations. Int Surg 72:42–44

    PubMed  CAS  Google Scholar 

  16. Kingsnorth AN, Sivarajasingham N, Wong S, Butler M (2004) Open mesh repair of incisional hernias with significant loss of domain. Ann R Coll Surg Engl 86:363–366

    Article  PubMed  CAS  Google Scholar 

  17. Okamoto E, Kyo A, Yamanaka N, Tanaka N, Kuwata K (1984) Prediction of the safe limits of hepatectomy by combined volumetric and functional measurements in patients with impaired hepatic function. Surgery 95:586–592

    PubMed  CAS  Google Scholar 

  18. Dello SA, van Dam RM, Slangen JJ, van de Poll MC, Bemelmans MH, Greve JW et al (2007) Liver volumetry plug and play: do it yourself with ImageJ. World J Surg 31:2215–2221

    Article  PubMed  Google Scholar 

  19. Wigmore SJ, Redhead DN, Yan XJ, Casey J, Madhavan K, Dejong CH et al (2001) Virtual hepatic resection using three-dimensional reconstruction of helical computed tomography angioportograms. Ann Surg 233:221–226

    Article  PubMed  CAS  Google Scholar 

  20. Tanaka EY, Yoo JH, Rodrigues AJ Jr, Utiyama EM, Birolini D, Rasslan S (2010) A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia 14:63–69

    Article  PubMed  CAS  Google Scholar 

  21. Goni Moreno I (1978) The rational treatment of hernias and voluminous chronic eventrations: Preparation with progressive pneumoperitoneum. Lippincott, Philadelphia

    Google Scholar 

  22. Johnson WC (1972) Preoperative progressive pneumoperitoneum in preparation for repair of large hernias of the abdominal wall. Am J Surg 124:63–68

    Article  PubMed  CAS  Google Scholar 

  23. De Santis L, Frigo F, Bruttocao A, Terranova O (2003) Pathophysiology of giant incisional hernias with loss of abdominal wall substance. Acta Biomed 74:34–37

    PubMed  Google Scholar 

  24. Astudillo R, Merrell R, Sanchez J, Olmedo S (1986) Ventral herniorrhaphy aided by pneumoperitoneum. Arch Surg 121:935–936

    Article  PubMed  CAS  Google Scholar 

  25. Barst HH (1972) Pneumoperitoneum as an aid in the surgical treatment of giant herniae. Br J Surg 59:360–364

    Article  PubMed  CAS  Google Scholar 

  26. Coelho JC, Brenner AS, Freitas AT, Campos AC, Wiederkehr JC (1993) Progressive preoperative pneumoperitoneum in the repair of large abdominal hernias. Eur J Surg 159:339–341

    PubMed  CAS  Google Scholar 

  27. Rives J, Pires JC, Flament JB, Palot JP (1987) Major incisional hernia. In: Chevrel JP (ed) Surgery of the abdominal wall. Springer, Berlin, pp 116–144

    Google Scholar 

  28. Pelosi P, Croci M, Ravagnan I, Tredici S, Pedoto A, Lissoni A et al (1998) The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg 87:654–660

    PubMed  CAS  Google Scholar 

  29. Tan PL, Lee TL, Tweed WA (1992) Carbon dioxide absorption and gas exchange during pelvic laparoscopy. Can J Anaesth 39:677–681

    Article  PubMed  CAS  Google Scholar 

  30. Connolly DP, Perri FR (1969) Giant hernias managed by pneumoperitoneum. JAMA 209:71–74

    Article  PubMed  CAS  Google Scholar 

  31. Kaafarani H, Hur K, Campasano M, Reda D, Itani K (2009) Classification and valuation of postoperative complications in a randomized trial of open versus laparoscopic ventral herniorraphy [abstract 221]. Hernia 13(Suppl 1):S69

    Google Scholar 

  32. Tanaka EY, Yoo JH, Rodrigues AJ Jr, Utiyama EM, Birolini D, Rasslan S (2010) A computerized tomography scan method for calculating the hernia sac and abdominal cavity volume in complex large incisional hernia with loss of domain. Hernia 14:63–69

    Google Scholar 

  33. Agnew SP, Small W Jr, Wang E, Smith LJ, Hadad I, Dumanian GA (2010) Prospective measurements of intra-abdominal volume and pulmonary function after repair of massive ventral hernias with the components separation technique. Ann Surg 251:981–988

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, Amiens University Medical Center, Place Victor Pauchet, 80054, Amiens Cedex 01, France

    C. Sabbagh, F. Dumont, D. Fuks, P. Verhaeghe & J.-M. Regimbeau

  2. Department of Radiology, Amiens University Medical Center, Place Victor Pauchet, 80054, Amiens Cedex 01, France

    T. Yzet

Authors
  1. C. Sabbagh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. F. Dumont
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D. Fuks
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Yzet
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Verhaeghe
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J.-M. Regimbeau
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to J.-M. Regimbeau.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sabbagh, C., Dumont, F., Fuks, D. et al. Progressive preoperative pneumoperitoneum preparation (the Goni Moreno protocol) prior to large incisional hernia surgery: volumetric, respiratory and clinical impacts. A prospective study. Hernia 16, 33–40 (2012). https://doi.org/10.1007/s10029-011-0849-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-011-0849-2

Keywords

Search

Navigation